Welcome
Please fill the form below to make an appointment with the International Medicine Department . Once the International Medicine Department receives your request of appointment, we will contact you to confirm your visit.
Please check with your insurance company or our direct billing company list to see if your insurance is accepted by our hospital. Appointments should be made at least 3 days prior to your visit. Please bring your passport, medical insurance card and medical records when you visit us.
*Birthday:
*Nationality:
*Passport Number:
*Permanent Address in China:
Contact Number(in China)
*Mobile Number:
*E-mail:
Emergency Contact
Name:
Relationship to the Patient:
Phone Number:
*Request Date:
*Request Department:
Preferred Physician:
*Enter the verification code:
Complaints:
Notes:
