Please read all information under the Visitor Requirement section prior to completing this request form.

This application is not complete until the following items are attached: 

  • Curriculum vitae (CV)
  • Two letters of professional reference from supervisors on company letterhead
  • Proof of health insurance coverage¬†
  • Completed immunization record [print form here]
  • $200 non-refundable application fee. Application fee will be deducted from total amount due.

IJHN accepts payment via credit card or wire transfer. We will contact you to determine your preferred method of payment.

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(Include country code if not in U.S.)
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Files must be less than 800 KB.
Allowed file types: txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.
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Files must be less than 800 KB.
Allowed file types: txt rtf html odf pdf doc docx ppt pptx xls xlsx xml.
Mandatory Health Insurance Requirements
International visitors are required to prove they have health insurance coverage that meets the following minimum requirements set by the U.S. Government: $50,000 per accident/illness; $7,500 for repatriation of remains; $10,000 for medical evacuation (return to home country).
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Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx xls.
Mandatory Immunization Requirement
To prevent any possibility of risk to patients, staff, and visitors, IJHN requires proof of immunity and health screening for several infectious diseases. Visiting any clinical area will not be permitted until these proofs of immunity and screening are provided.
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Immunizations (or other proof of immunity) are required for Hepatitis B, Measles, Mumps, Rubella (German Measles), Polio, Varicella Zoster (Chicken pox), Tetanus, Diphtheria, and Influenza. PPD screening or other documentation of tuberculosis clearance is required.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt html pdf doc docx xls xlsx.