Make an appointment

Appointment form

When you are ready to make your appointment, after you have booked your flight, please supply the following information (submit the form below).

Extra care is taken to ensure the confidentiality of your personal information and it is shared only with the hospitals and their staff for the purpose of setting up a medical appointment.

* Your name.Invalid format.
* Your family nameInvalid format.
* Your email address.Invalid email address.
Phone number.Invalid phone number.
Invalid format.
Invalid format.
Invalid Zipcode.
Please select a country.
Invalid format.
Date of birth
Invalid passport number.
Invalid airline or flight number.
Arrival date & time
Please select an item.
Appointment date *
Select month. Select date.
Surgery Procedures (You can also select multiple procedures in the list). Please select a or multiple procedure.
Write your medical history or allergies.
All fields marked with an (*) are mandatory.

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