QUESTIONNAIRE FOR BANK TRANSFERS (PATIENT)

QUESTIONNAIRE FOR BANK TRANSFERS (PATIENT)

Patient's Full Name
Patient's Full Name
First Name
Last Name
Are you a permanent resident in the United States?
Do you have any status that links you to the United States?
$USD

Important Notes:

  1. Please note the total cost of the treatment must be paid in Canadian dollars only (the currency of our corporate head office). CubaHeal will not accept any payment from any US financial institution, US-based financial institution or a wire transaction in US dollars. Any payment forwarded to us in US dollars, or from a US-based financial institution will be reversed less applicable wiring fees.

  2. USD/CAD exchange rate fluctuate. Patients are responsible for any discrepancy or shortfall resulting from such fluctuation

  3. CubaHeal charges CA$200.00 as a service fee for every wire transmission to the CSMC
  4. Patients are responsible for all applicable exchange fees. To that end, kindly be aware CubaHeal applies the following formula:
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