ENG Medical

Full Complete Name*

Date of Birth*

Yacht/Vessel Name*

Your Email*

Permanent Address Street*

Permanent Address City*

Permanent Address Country*

Permanent Address Postcode*

Phone number*

Whatsapp Number (if different)

Country and Passport Number*

Dual Nationality Country and Passport Number

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Preparation for the Medical Appointment

You must tick EACH ONE that you agree/ confirm understanding:

I agree to bring a passport or driving licence or book and understand that a National Identity Card is not accepted by the MCA ADIS system.I agree to bring my previous original ENG certificate (or other Seafarers medical) and understand it will be uploaded to the online MCA ADIS system. I understand that failure to produce the previous original can result in the medical being terminated at my own cost.I agree to bring my eyeglasses if I wear them. If I do not bring them this may cause the appointment to be terminated at my own cost and a second appointment will become necessary.I agree to remove my contact lenses if I wear them, at least 3 hours prior to the appointment. Failure to do so, may cause the appointment to be terminated at my own cost and a second appointment will become necessary.I agree to attend prepared to provide a urine sample. If I cannot provide this during the allotted time for my medical, it may be the cause for the appointment to be terminated at my own cost. A second appointment will then be necessary.I agree to avoid loud noises for 48 hours prior to the appointment to be able to do the hearing test.I agree to bring hospital reports for any recent medical treatment(s) which might affect the outcome or progress of my ENG medical assessment. I understand that if these cannot be provided, the ADIS will not allow the medical to continue and the appointment will have to be terminated at my own cost. A second appointment will be necessary.I agree that I will bring all medical reports pertaining to any pre-existing medical conditions I may suffer such as high blood pressure, heart conditions, cancer, allergies, epilepsy, allergies etc. I understand that if these cannot be provided, the ADIS will not allow the medical to continue and the appointment will have to be terminated at my own cost. A second appointment will be necessary.I agree to bring a letter from my dentist confirming a check-up within the past 2 years. This should merely state; 'no treatment required' or 'treatment competed'.I agree to wear suitable discreet underclothing as I will have to undress to my underwear (as per the MCA regulations for the ENG Medical).

Terms and Conditions

You must tick EACH ONE that you agree:

I agree that I have double checked the appointment date and time as arranged by phone, WhatsApp or email.I agree that if I do not attend the appointment (for whatever reason), I will pay 100% No Show Fee to Club de Mar Medical (unless agreed in writing otherwise).I agree and understand that if I cancel within 6 working hours of the appointment, I will pay 50% cancellation fee to Club de Mar Medical (unless agreed in writing otherwise.)I agree to pay the ENG fee of €175 either by credit/debit card, bank transfer or cash. Club de Mar Medical does not accept notes. Payment by card results in a 2% supplement to cover bank charges.I understand that if I must return for a second appointment, because I do not have the necessary paperwork at the first, the second appointment will be charged at an additional.I understand that the medical will take place in English and will bring a translator if necessary. There is a consent form concerning the privacy of personal information and the examination required, which I need to sign during the appointment (copy on our website).I agreed to inform Club de Mar Medical if I require a chaperone.

By ticking this check box, you confirm that you have read the following basic data protection information:
The data controller is Dr Johanna Pamela Clark (Club de Mar Medical). The purpose of the processing is to attend your request. You may exercise the rights of access to your data, to rectification, erasure or data portability as well as the rights to restriction or objection to its processing and to file a complaint with a Data Protection Authority. + Info on the processing of your personal data and your rights in our privacy policy