The medicine chart is ONLY for those taking prescribed medication. For the case of a medical emergency, we will have vital information about your current medical condition and medicine consumption. The form also gives facilitators and guides an indication on how to schedule breaks during our program or necessary arrangements to meet your medical needs.
The form will not be used in any way other than specified. No unauthorized persons will have access to personal data unless requested in written form by yourself to email@example.com
By signing the form you agree to the terms and conditions outlined here and that the information you provide is true and accurate.
Click here to fill out or download the medicine chat