Summit Travel Medical Kit – Order Form

Complete this form and our team will prepare your kit before your trip.

Included in the standard kit

Instruction Guide
Amoxicillin 500mg – 28 tabs
Augmentin 875/125mg – 28 tabs
Azithromycin 500mg – 6 tabs
Cefdinir 300mg – 28 tabs
Ciprofloxacin 500mg – 28 tabs
Doxycycline 100mg – 28 tabs
Metronidazole 500mg – 28 tabs
Loperamide (Imodium) 2mg – 12 tabs
Ondansetron (Zofran) 4mg – 60 tabs
Ciprofloxacin eye drops – 5mL vial
Bacitracin ointment – 30g tube
Triamcinolone Cream – 15g tube
Wound Seal powder – 2 vials
Strep Test Kit
Urinalysis strips

Your information

First name * Last name *

Email * Phone number *

Travel date * Traveling with children?

Destination * Specific travel concerns

Optional add-ons (extra cost)

Standard kit$295.00

Add-ons$0.00

Total $295.00

Acknowledgement *

I understand this kit is intended for use as directed and does not replace medical evaluation when needed. I understand that a provider will review my request and may adjust medications based on medical history. I consent to Summit Direct Care preparing this kit and billing my account accordingly.

You'll receive a confirmation email with your order summary. Payment is processed when your kit is prepared — there is no charge at submission.