Please complete the information below, indicating which check-up you are most interested in. Someone from the medical team at Bangkok Heart 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 Heart Hospital, please click here for a more detailed form and ignore the one below.

Heart Health Evaluation Appointment Request

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

Choose the exam you prefer:    

Choose any optional extras:

Your full name:  

Your age:   Gender:

Country of Residence:  

Passport Number:

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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