REGARDINGNoAdvice FEES

GENERAL CONDITIONS


  1. Understand the fees
  2. Sign waiver electronically
  3. Make a donation to ITACI


REGARDING FEES

  1. USAppointment is a non-profit company. We dedicate all of our work to help people gain access to the best possible cancer treatment options. Our only reward is to allow this result to reach as many people as possible, including the less fortunate ones.  In this spirit, we ask you to help us with our mission by making a donation to ITACIInstituto de Tratamento de Cancer Infantil.  We kindly suggest a minimum donation amount of R$ 4,000 (four thousand Brazilian Reais).

  2. We work in cooperation with Sansa Health, www.sansahealth.org, a US firm totally independent from this portal, which will coordinate your medical records to be used in the United States and schedule appointment(s) on your behalf.
    The fee for Sansa Health is US$1,500. which Includes the coordination of medical records to be professionally translated (third party, charged separately), assistance with hospital forms, scheduling and coordination of your case with hospital and support with lodging.

Please note: These fees refer to the service of scheduling the appointment(s) only and do not include costs of translation or any hospital/doctor appointment/service which will be charged separately.

Patient:
ID (RG):*
CPF:*

If patient is under 18 years of age, parent or guardian must sign.

Signee Name:
Relation to Patient:
ID (RG):
CPF:

I Understand



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