Application Form | Fit to Cruise Medical Certificate

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Your Details

Name *

First

Last

Mobile Number *

Email Address *

Your certificate will be sent to this email address

Date of Birth *

Sex *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Your Medical History

Are you currently pregnant? *

Do you have any pre-existing medical conditions? *

If yes, please give us further details here: *

Are you currently taking any medications? *

If yes, please list the medications you take here: *

Do you have any known allergies? *

If yes, please give us further information here: *

Have you undergone any significant medical procedures in the last 12 months? *

If yes, please give us further information here: *

Do you have any physical mobility restrictions or requirements? *

If yes, please give us further information here: *

About Your Pregnancy

Is your antenatal care in the United Kingdom? *

Where are you receiving antenatal care? *

Please provide the name of the health centre, health service or NHS trust.

How many weeks pregnant are you? *

What is your estimated delivery date? *

How many weeks pregnant will you be on the date you plan to travel? *

Please note that we cannot issue a certificate for a gestation of 36 weeks or greater

Is this a single or multiple pregnancy? *

Single
Multiple

Have you had any complications or medical issues during your pregnancy? *

If yes, please give us as much detail as possible here: *

Has any healthcare professional advised you not to travel by cruise ship? *

If you selected yes, please give us as much detail as possible here: *

Have you told your midwife or obstetrician that you plan to travel by cruise ship? *

Did your midwife or obstetrician consider you safe to travel by cruise ship? *

If you selected no, please tell us why: *

Have you ever been advised by a healthcare professional that your pregnancy is complicated or high-risk? *

If you selected yes, please give us further details about why this is the case: *

What was your BMI at the start of your pregnancy? *

Underweight: Below 18.5
Healthy: 18.5 - 24.9
Overweight: 25.0 - 29.9
Obese: 30 or above

What was your most recent blood pressure reading? *

Below 90/60 mmHg
Between 90/60 and 140/90 mmHg
Above 140/90 mmHg

When was this blood pressure taken? *

Less than 1 month ago
1-3 months ago
More than 3 months ago

Do you have or have you ever had any of the following conditions? (please select at least one option) *

I have never had any of these conditions
A history of blood clots (deep vein thrombosis)
High blood pressure
Diabetes Mellitus or Gestational Diabetes
Sickle cell disease or trait
Complicated previous pregnancy
Miscarriage after 18 weeks
Previous early onset labour (< 37 weeks)
A heart or lung condition
Epilepsy
Pre-eclampsia or Eclampsia
Abnormalities of the placenta
Any blood disorders
Severe Anaemia
Low Lying Placenta
Low PAPP-A

If you selected any of the conditions above, please give us as much detail as possible about them here: *

Do you have any other medical conditions that were not listed above? *

If yes, please give us further details about the medical condition(s) you have: *

Is this an IVF pregnancy? *

Are you currently take any medications? *

If yes, please list your medications here: *

Have you been advised to take aspirin during your pregnancy? *

If you selected yes - please tell us the reason why here: *

Your Travel Plans

Purpose of Travel *

If you selected Other, please give us further detail here: *

Where are you travelling to? *

Date of Outbound Trip *

Name of Cruise Company *

Identity Verification

Please upload an IMAGE of a form of photographic ID to verify your identity (e.g. passport, driving licence). *

Click or drag files to this area to upload. You can upload up to 100 files.

Antenatal or Maternity Notes

Important: Please Read Carefully

To provide a fit-to-fly certificate, we must confirm your pregnancy is uncomplicated. For this, you must submit your most recent Maternity Notes, which include updates from your midwife or doctor on how your pregnancy is progressing. These notes typically cover any complications noted during your antenatal appointments. If you don't have these, please contact your midwife to obtain them.

Without this information, we cannot issue your certificate.

Note: Simply submitting scan results or brief pregnancy details is insufficient. If your antenatal care is in the UK, you should have access to written or digital maternity notes. If not, please arrange this with your midwife.

Please upload a scanned copy, clear photos, or screenshots of your Maternity Notes here: *

Click or drag files to this area to upload. You can upload up to 100 files.

NHS Summary Care Record (UK) or Medical Summary (non-UK)

This provides a summary of key health information from your medical records. You can obtain this from your GP or family physician, online healthcare records or NHS App. If you're unsure how to access it, please contact your registered medical practice or email us at hello@wilmerhealth.co.uk.

Please upload a copy or images of summary of your medical records here: *

Click or drag files to this area to upload. You can upload up to 100 files.

Additional Documents

We can complete and sign any extra documents that are needed by your airline or other parties. There is a one-time fee of £25 for any additional forms that require signing. If you have any questions about this, feel free to email us at hello@wilmerhealth.com, and you’ll receive a response within hours.

Do you have any other documents that need to be signed? *

Please upload any additional documents that need signing here: *

Click or drag files to this area to upload. You can upload up to 100 files.

Anything Else? (Optional)

Is there anything else you'd like to add to your application? (Optional)

If there are any other documents you would like to upload as part of your application, please do so here: (Optional)

Click or drag files to this area to upload. You can upload up to 100 files.

Terms and Conditions

Upon submitting your application, you acknowledge our Terms and Privacy Policy and consent to the following:

You confirm that you have understood all the questions in the questionnaire and have answered them truthfully.
The certificate you are requesting is intended exclusively for the person whose name and details have been provided.
You acknowledge the potential risks associated with travel, including possible health complications, and accept full responsibility for your decision. Wilmer Health and our doctors bear no liability for any adverse events that may occur at any time.
You agree to release Wilmer Health and our doctors from any responsibility for any negative outcomes affecting you or others at any point in time.
You understand that Wilmer Health does not provide consultations. Our certificates are based solely on the information you have provided, indicating no reported contraindications to travel, to the best of our knowledge. This service does not substitute for a medical consultation, diagnosis, or treatment, and we assume no liability for any adverse events.
You acknowledge that our certificates are meant to confirm, based on available medical evidence, that no contraindications to travel exist. These certificates are not guarantees, insurance policies, or medical indemnity coverage against potential health events.
You recognize that Wilmer Health is not a substitute for a visit to your GP or primary healthcare provider. Our doctors do not have access to your NHS or regular medical records.
You confirm that no other healthcare professional has advised you against traveling.
You confirm that you have provided all relevant medical information and have not intentionally withheld any details.
You acknowledge that once your certificate request has been reviewed by our doctor and the letter issued, no refunds can be processed.
You understand that if a third party, such as a cruise line or insurance provider, rejects a certificate from Wilmer Health, neither Wilmer Health nor our doctors are liable for any related costs.

Upon submitting your application, you acknowledge our Terms and Privacy Policy and consent to the following:

You confirm that you have fully understood all the questions in the questionnaire and have answered them truthfully.
The certificate you are requesting is intended solely for the person whose name and details have been provided.
You acknowledge the potential risks of traveling while pregnant, including possible health risks to both you and your baby, and take full responsibility for your decision. Wilmer Health and our doctors bear no liability for any adverse events that may occur at any time.
You agree to release Wilmer Health and our doctors from any responsibility for any adverse outcomes affecting you, your unborn child, or any other party at any time.
You understand that Wilmer Health does not provide consultation services. Our certificates are issued based on the information you have provided, indicating no reported contraindications for traveling while pregnant, as well as any available maternity notes. This is not a medical consultation, diagnosis, or treatment, and we assume no liability for any adverse events involving you or your baby.
You acknowledge that our certificates confirm there are no contraindications to travel based on the medical information provided. These certificates are not guarantees, insurance policies, or medical indemnity against potential complications.
You recognize that Wilmer Health is not a substitute for a visit to your GP, midwife, or primary healthcare provider. Our doctors do not have access to your NHS or regular GP medical records.
You confirm that you have informed your midwife or obstetrician of your intention to travel, and they have not advised you against it.
You confirm that you have provided all relevant maternity or antenatal notes and have not intentionally withheld any information.
You confirm that you are currently receiving antenatal care from a registered provider in the United Kingdom.
You acknowledge that once your certificate request has been reviewed by our doctor and the letter issued, no refunds can be processed.
You understand that if a third party, such as a cruise line or insurance provider, rejects a certificate from Wilmer Health, neither Wilmer Health nor our doctors are responsible for any related costs.

Agreement to Terms and Conditions *

I have read and agree to the Terms and Conditions listed above

Checkout

Fit-to-Cruise Certificate

Price: £45.00

Fit-to-Cruise Certificate + Additional Document(s)

Price: £70.00