Spain Intake Form

Demographics:

Name*

Email:*

Phone:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am a

Medical student
Resident
Fellow
I already completed my medical training

For trainees to qualify for the discounted rate please upload your valid medical student, resident, or fellow ID.*

Max. file size: 256 MB.

Medical Specialty & Training

Are you a:*

MD
DO

What medical school did you attend?*

Medical Specialty*

Did you complete or are you completing an ACGME or AOA accredited residency program?*

Yes
No

What residency and/or fellowship program did you attend?*

Are you American-board certified in your specialty:*

Yes
No

I am currently working in: (check all that apply)

Hospital
Outpatient Clinic
Private Practice
Non-Clinical Role
Telemedicine
Other

I currently hold active medical licenses in these states: (please list all your active state medical licenses)

Immigration:

Are you relocating with: (check all that apply)

Partner
Children
Other Dependents
No other dependents

Current Citizenship or Permanent Resident Status (list all of your Citizenships)*

When are you hoping to move to Spain? (ie in 1-2 years etc)

Language Skills

How well do you speak Spanish?*

I do not speak Spanish
Beginner Spanish (A1, A2)
Intermediate Spanish (B1, B2)
Advanced Spanish (C1, C2)
Fluent or Native Spanish Speaker

Are you open to improving your current Spanish language skills?*

Yes
No

Financial Status

I am:

Financially Free
Positive net worth but not yet financially free
Negative net worth

What yearly income do you expect after moving abroad?

Your Dream

Why are you hoping to relocate to Spain?*

What concerns or obstacles have kept you from moving to Spain?*

What questions are you hoping your Adventure Guide can help with?*

Anything else you are hoping to attain from this session? Anything else you would like your Adventure Guide to know?

Promo Code

Payment*

I agree to the current fee schedule.

For a new 1 hour guidance session with 30 days of email support, your investment is $649 or $549 for trainees. You will receive an invoice upon review and acceptance of the intake form.

Consent*

I have read, understand, and agree to the Terms of Use

Prove your humanity:

Hold Up!

Demographics:

Medical Specialty & Training

Immigration:

Language Skills

Financial Status

Your Dream

Become a Hippocratic Adventures Insider

Spain Intake Form

Hold Up!

Demographics:

Medical Specialty & Training

Immigration:

Language Skills

Financial Status

Your Dream

Become a Hippocratic Adventures Insider

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