Post-Mission Trip Report

Thank you for sharing our commitment to helping patients in need. Please fill out this form to help us document the incredible impact that you made changing patient lives and better support you in the future. If you have questions, please email jcali@globusmedical.com.

Post-Mission Trip Report

Name(Required)

First Last

Email(Required)

Phone(Required)

Nonprofit/Group Name(Required)

Mission Trip Location(Required)

Mission Trip Dates(Required)

Mission Trip Hospital Name(Required)

How many surgeries were performed?(Required)

What types of surgeries were performed?(Required)

How many patients were seen in clinic?(Required)

Please list your mission team participant names and their role(Required)

Please summarize your trip(Required)

Please share a patient anecdote or story(Required)

Please list any social media handles that you would like us to tag if we post about your trip

Please upload your favorite trip photos/videos

Drop files here or

Accepted file types: jpg, png, gif, heic, Max. file size: 50 MB.

Please only upload files that you have permission to share publicly.

How was your experience working with Globus Cares?

As we expand our program, we are also working to improve our processes. Please share any feedback you may have.

Is there anything else we should know or take note of?

Are you planning to request support from Globus Cares again?(Required)

If yes, please share any future trip details/info that that you have.

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