3) Travel Itinerary Form (Flights) ✈️

Travel Itinerary

Submit your itinerary details below to schedule your ground transportation pickup/ drop-off.
Which city are you traveling to for your procedure?*

San Diego, CACartagena, Colombia
Will you be traveling with a companion?*

YesNo
Client Name*

First NameLast Name
Client Email*
example@example.com
Travel Companion

First NameLast Name
Travel Companion Phone
Arrival Flight Details

Arriving at San Diego International Airport
Arrival Flight Details

Arriving at Rafael Núñez International Airport
Arrival Flight Airline*
Arrival Flight #*
Date of Arrival*

MonthDayYear
Date
Time of Arrival (in PST)*

Hour Minutes

AM/PM Option
Departure Flight

Flight Home from San Diego International Airport.
Departure Flight

Flight Home from Rafael Núñez International Airport
Departure Flight Airline*
Departure Flight #*
Date of Departure*

MonthDayYear
Date
Time of Departure (in PST)*

Hour Minutes

AM/PM Option
Patient Signature*

Clear
Please verify that you are human*
Should be Empty:

Travel Itinerary