Emergency Medical Kit Questionnaire: Recreational Vessel

For Recreational Vessels
Commercial Vessels Click Here

Please answer the questions below and click the submit button to e-mail your completed questionnaire to us. We will contact you with a quote for your customized medical kit.

Captain / Owner

Name:
e-mail:
Company:
Street Address:
City, State, Zip:	,
Phone (work / home):

Vessel

Size:
Type:	If Other:
Primary Use:	If Other:
Engine Type:	If Other:

Additional Information

*Emergency Medical Kits featuring prescription medication require 10 working days for preparation.
On an average boat outing, how far are you from assistance?
What is your operating area?
What is the typical water temperature?
What is the typical air temperature?
On average, how many people are on your vessel?
Do you or your crew have any chronic illnesses, or are you on any special medications?
What are the average sea and weather conditions in which you will be operating?
Who is your family physician? (Name, address, telephone)
Specific size allocated for medical kit?
Do you have a transmitter/receiver on board?	No Yes - What type?:
Do you have any medical experience?	No Yes - What type?:
When will you be needing your kit?*
Please send us your comments and questions.

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