Mission Trip Report Form

Please share your trip with us! Return this form completed with the requested information along with any photos, videos and first person experiences you're willing to share.

Basic Info

Name of Organization (required)

Contact Name:

Contact Email:


Date of Trip (required)

Location of clinics: (name of cities, villages, providence and country)


Clinic/Hospital/Pop-Up Clinic Name:

Number of Beds
Number of Stations

Services Info: Did you offer?

Medical CareDental CareVision CarePublic Health EducationTraining for Local Health Professionals (What kind?)

Client Info:

# Ages: Birth-18 19-59 60+

# Female: Birth-18 19+

Were all of the medicines provided used?:

Were all of the supplies provided used?:

If no, what did you do with the excess of each?:

What else would you like us to know? (Share a favorite story, give us a trip blog to check out, give us a suggestion, etc.)

"I hereby give permission for photos submitted to Brother’s Brother Foundation to be used in publications both physical and digital. This may include: newsletters, website, press releases, Facebook and other uses as the organization sees fit. (credit will be given to the group submitting the photos.)" (required)

Please send all pictures to mission@brothersbrother.org

Data may take a few moments to submit