My Page Title

Medical clearance application


Do you have any documents/files to attach?*
Please compile all medical reports and other supporting documents into one pdf file and upload.*

123455
James
Smith
55 55 666
James@travels.com
Continue
Back
Continue

I consent to the use of my medical data contained in this form and any supplementary medical data requested by Etihad in relation to this application. I understand that my medical information will be processed by staff at any of Etihad’s contact centres in the UAE, Serbia or India, or at any of Etihad’s ticketing offices worldwide. I am also aware that my data will be reviewed by the Etihad Airways medical assistance team in the UAE and will be used by airport staff to facilitate my travel arrangements at my departure, transit and final destination airports.


Read our privacy policy to find out more about how Etihad uses your data and protects your privacy.

I authorise (name of nominated physician) to complete Part C of this form for the purpose as indicated. I relieve the physician of their professional duty of confidentially in respect of such information and agree to meet any fees associated with this. I understand that if accepted for carriage, my journey will be subject to the conditions of carriage. I understand that I travel at my own risk and release the carrier, its employees, servants and agents from any liability. I agree to reimburse the carrier upon demand for any special expenditures or costs in connection with my carriage. I have read and understood MEDIF Part A.

  • Ensure you provide the correct contact details for your doctor
  • Inform your doctor that a link will be sent to their email address for them to complete the form
  • It is your responsibility to liaise with your doctor to ensure the form is submitted correctly

Back

Summary

123455
James
Smith
55 55 666
James@travels.com
James
Smith
John@email.com
8888765654
EYRTGH
Smith
Departure Airport Arrival airport Departure date and time Arrival date and time Airline code Flight number Class of service
Departure Airport Arrival airport Departure date and time Arrival date and time Airline code Flight number Class of service
A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis assesses the factors in the broader situation that could impact the implementation of your program or its ultimate success.
      Jeny Parker
      KJHYGF
      John
      John
      abcd@gmail.com
      Fortis
      9999898989

      Thank you!