Please complete the information below, indicating the services you are most interested in. Someone from the medical team at Bangkok Hospital will reply to you as soon as possible. If you do not want to schedule a physical exam but want to request information about other services from Bangkok Hospital, please click here for a more detailed form and ignore the one below.

Health Evaluation/Comprehensive Physical Examination

I would like to schedule an appointment for (enter date):
Number of people:   

Your full name:  

Your age:  Gender:

Country of Residence:  

Email:

Where do you plan to stay in Bangkok?

Please use the space below to ask questions or to tell us anything you think we should know about your health before your appointment:



About Private Information
All information entered into this form will be held in the strictest confidence and will be evaluated by health care professionals for the purpose of providing competent advice about health care that may be available to you. Nothing entered here will be made available to anyone not directly related to the health issues at hand or used in the future to offer unrelated services.

 

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