Medical Inquiry Information

Package Of Interest

Type of Inquiry *

Doctor *

Patient Health Information

Please describe present diagnosis, medical history, or health condition.

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Have you selected a doctor at Bumrungrad?

Yes

Patient Advocacy Program

Bumrungrad has a patient advocacy program that provides our international patients and their families with assistance to voice out their questions, requests, concerns, or feedback in their preferred language.

Need cultural support services ?

Yes

Cultural Support Services

Your concerns *

For medical issues and communication between your home country physicians and ours, we have an international team of coordination physicians to support you. Medical Coordination Office

Allow a coordination physician communicates with your Home Physician?

Yes

Name of Doctors *

Contact Number / Email Address *

Your concerns *

Procedure of Interest *

Your Question *

Personal Information

First Name *

Last Name *

Date of Birth *

Gender *

Male

Female

Country of Residence *

Nationality *

Email *

Confirm Email *

Visited Bumrungrad before?

Yes

Mobile Phone

Agree To Terms & Service

Inquiry to a Bumrungrad referral office in my country

Country of Bumrungrad office *

Bumrungrad office *

Topic of Inquiry *

Your Question *

Personal Information

First Name *

Last Name *

Date of Birth *

Gender *

Male

Female

Country of Residence *

Nationality *

Email *

Confirm Email *

Visited Bumrungrad before?

Yes

Mobile Phone

Agree To Terms & Service

Package Inquiry

Medical Inquiry Information

Patient Health Information

Patient Advocacy Program

Personal Information

Inquiry to a Bumrungrad referral office in my country

Personal Information