Submit Medical Inquiry

Request Treatment Plan

For inquiries call 24/7 Hotline +66-25-44-0001 or chat on Messenger, WhatsApp or LINE.

Patient Name *

Email Address *

Contact Number *

Are you currently in Thailand? *

Yes

Describe patient's symptoms, conditions and medical history *

Are you currently experiencing any symptoms? *

Yes

Are you currently taking any medication? *

Yes

Upload Medical Reports from the past 6 Months (Optional)

.jpg, .png, .jpeg, .pdf, .docx (Multiple Files Allowed)

Upload Passport (Required for Patient Registration) *

.jpg, .png, .jpeg, .pdf, .docx (Multiple Files Allowed)

Share Google Drive/Dropbox or other URL for Medical Imaging Data (Optional)

DISCLAIMER: The information on this page has been collected from the provider owned portals, and as such MediX cannot be held responsible for the content herein. This page was last updated on 2022-07-08 110000.

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地　　址：帕亚泰医院集团—中国中心

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