MAP International Prescription (Rx) Mission Pack Application

For Travel with a Medical Practitioner
For Prescription Packs

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.

Practitioners Agreement
 
 

Part 2

Click on the document image below to complete the form.

 
Partner Information Form

 

Have Questions?

MAP's Customer Service team can be reached by phone at 1-800-225-8550 Monday thru Friday - 8am to 5pm (EST)

Mission Feedback Form

Please remember that in order to remain eligible for the MAP Medical Missions Program, you must complete the Medical Missions Feedback Form.