International Travel

Your treatment is provided via A J Mander Pty Ltd

(ABN 59681306874) trading as

embracing ADHD

'Procrastinate Later'

TRAVEL FORM

You must check the import regulations for any country you are visiting or transiting through. Ensure you take your medication in the packaging as dispensed and carry it in your hand luggage so you can show it to customs if required. Do not take more than you need for the trip. On receipt of this form we can issue you with a travel letter.
Name*

FirstLast
Email*
example@example.com
Date leaving Australia

DayMonthYear
Date
Date returning to Australia

DayMonthYear
Date
Will you be away from Australia for more than 3 months. If yes, you must seek local medical services if you are having problems.*

YesNo
Are you visiting the USA during your trip? If yes you must seek local advice if you are having problems. We are not allowed to provide you with medical services for any period for which you are in the USA.*

YesNo
Do you need any changes to your dispensing arrangements for your medication?*

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