– Medical Travel Quality Alliance | MTQUAMedical Travel Quality Alliance

Welcome to the first step in achieving Medical Tourism Certification. Please provide us with the following information so we can begin the certification process.

Once we receive this application form, we will contact you about preparing for the evaluation. You should expect a call or email within a few days.

If you haven’t yet done so, please download Guide To Medical Tourism Certification for details about the evaluation process and the fee schedule.

CERTIFICATION APPLICATION

Name Of Business To Be Certified*
Your Name*
Your Title/Position*
Your Email Address*
Contact - Telephone and/or Skype (with country code)*
Business Web Site Address*
Type Of Business Or Organization*
Please describe your "Other" type of business.
Complete Business Address*
Is This Also The Billing Address?*
Yes
No
Billing Address And Information
If you have a different address or special requirements for billing, invoices, or payment transfers, please tell us what these are so that there will be no delay in processing this application.
How Old Is This Business?*
When Did This Business Serve Its First Medical Tourist?*
How does a medical tourist usually first make contact?*
In the past 2 years, has this business had its own office or agent in any other country? If so, please describe.*
In the past 2 years, has this business conducted significant medical tourism-related activity in more than one LANGUAGE? If so, please describe.*
In the past 2 years, for which medical or health care specialties have you ACTUALLY PROVIDED service? (Select up to 5 by holding down Control Key.)*
Specify other treatments
In the past 2 years, what portion of business revenues was derived from medical tourism-related activities?*
In the past 2 years, how did this business MAINLY acquire customers or patients? (Select up to 3 by holding down Control Key.)*
What Organizations Is This Business A Member Of?
Why Are You Considering Medical Tourism Certification?
PRIVACY
I understand that by providing this information I consent to receive communication sent by or on behalf of MTQUA. I also understand that MTQUA will not share my email address with other organizations.
DECLARATION*
I confirm that I am duly authorized to make this application for certification on behalf of the named business. I verify that the information provided is true and accurate. I understand acceptance to the certification process is not automatic, and will be reviewed by the MTQUA Certification Committee. I accept that this business will be billed for the amount of the certification application fee, and have provided billing information for this purpose.
(Signed) Your name*
Title*
Date (DD/MM/YYYY)*

DD
MM
YYYY

CAPTCHA

-- select --
Addiction treatment or rehab
Cancer treatment
Cardio-thoracic surgery and cardiology
Cosmetic and reconstructive surgery (inpatient)
Cosmetic surgery procedures (outpatient)
Dental surgery
Dental treatment
Dermatology
Ear nose throat surgery
Eye surgery
Fertility treatment
Gastroenterology
General surgery
Hair transplantation
Health screening or diagnostic testing
Neurosurgery
Obstetrics and gynecology
Organ transplantation
Orthopedic surgery
Orthopedic rehabilitation
Pediatric treatment or surgery
Spine surgery
Stem cell treatment (inpatient)
Stem cell treatment (outpatient)
Urology
Weight loss (bariatric) surgery
Other (specify below)

Welcome to the first step in achieving Medical Tourism Certification. Please provide us with the following information so we can begin the certification process.

Once we receive this application form, we will contact you about preparing for the evaluation. You should expect a call or email within a few days.

If you haven’t yet done so, please download Guide To Medical Tourism Certification for details about the evaluation process and the fee schedule.

CERTIFICATION APPLICATION

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