Bausch Foundation MEDICAL MISSION PROGRAM

Bausch Foundation
Medical Mission Program Application
Rx Pack

 Please note, you must complete the forms and submit them properly before your application is complete. Expedited service to meet travel deadlines and deliveries to Alaska and Hawaii incur additional charges.

Part 1

Click on the document image below to complete the form.

Screen Shot 2020-06-23 at 12.00.09 PM

Part 2

Click on the document image below to complete the form.

Screen Shot 2020-06-23 at 11.53.20 AM

 

Please complete, sign and submit the following 4 forms and a member of the MAP Team will be with you shortly. Please note, you must complete all 4 forms and submit them properly before your application is complete. Expedited service to meet travel deadlines and deliveries to Alaska and Hawaii incur additional charges.

 Have Questions?

MAP's Customer Service team can be reached by phone at 1.800.225.8550 Monday thru Friday - 8am to 5pm (EST) 

 
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