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Corporate Information JCI Accreditations and Awards Investor Relations Factsheet Bumrungrad in Your Language What People Say about Us News

Who We Are

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Patient Services

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Package Inquiry

The below inquiry form is to find out more information about Packages which Bumrungrad International offers.
If you have general, non-Package related questions, please use our General Inquiry Form where you will have more options to select.

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Medical Health Related

Package Inquiry Information
	(*) required information
Package Of Interest* :	Please select package of interest
Type of Inquiry* :	Please select type of inquiry
Name of Doctor* :	Please select doctor's name
* :	Please select procedure of interest
I Inquire for*:	MyselfFriends / Relatives

Patient Information
First Name :	(As shown in your passport/ID card)
Last Name :
Date of Birth* :	Invalid date
Gender* :	MaleFemale
Country of Residence*:	*
Nationality:
Visited Bumrungrad before? :	NoYes
Hospital Number :

Patient Health Information
Please describe present diagnosis, medical history, or health condition. * :	Please describe
Attach File	Loading... (Accepted file formats: pdf, doc, jpg \| Total limit 8 mb in size)
Have you selected a doctor at Bumrungrad?* :	NoYes
Doctor Name* :	- Please Enter Doctor Name

Your Question*:

My Personal Information
Email* :	- Please enter your email - Email format is invalid
Retype Email* :	- Please retype your email - Email and retyped email do not match
First Name* :	- Please enter your first name (As shown in your passport/ID card)
Last Name* :	- Please enter your last name

Date of Birth* :	Invalid date
Gender* :	MaleFemale Please select gender
Country of Residence* :	* Please select country
Nationality :
Visited Bumrungrad before?	NoYes
Hospital Number

Mobile Phone :

(including country code)

Travel Plan

Do you need us to help you to book for hotel accommodation?

Yes See hotels granted corporate rate for Bumrungrad Hospital.

Greeting from Business Center, Bumrungrad International Hospital.

Would like to book the hotel.

(Please choose the following hotels and wait for our email booking confirmation or email to businesscenter-hotelreservation@bumrungrad.com if you do not receive any response within 24 hours)

Check in date:
Check out date:
Room Night :
Number of Rooms
Special request	(Special requests cannot be guaranteed – but the hotel will do its best to meet your needs)
Please provide us your credit card details. Your card will not be charged — it's only needed to guarantee your booking.
Enter your reservation guarantee.

Credit Card Information Credit Card Number Holder Name Expiration Date
Length of Stay:
Number of people

Note: The hotels granted corporate rate for Bumrungrad International Hospital, Please book via Business Center and pay directly to the hotel. The hotels request for booking guarantee by credit card. The booking cancellation must made by 48 hours, otherwise 1 night cost will be charge by the hotel.

Please provide us your credit card details to secure your booking. No charge will occur for this reservation.

I do not want to book the hotel at the moment.

(Please be informed that no hotel booking will be made.)

Price Ranges of Room(s)

<$75/Night
$75-$100/Night
$101-$125/Night
$126-$150/Night
>$150+/Night

By submitting this inquiry form, I agree that

Any dispute or claim (including injury claims) related to health care services received from Bumrungrad International that is not resolved by mutual agreement is subject to Thai law and the exclusive jurisdiction of the appropriate court in Thailand.
The information or any related detail including an estimated price is intended only for the person making the inquiry and cannot be claimed or referred to by other people.
The medical information and any estimated costs supplied are subject to change without notice due to a change of medical condition or unforeseen factors.

Please read the terms of use and click "I agree to the terms" to continue.

I agree to the termsI do not agree to the terms

Response Time: During this time, Bumrungrad will reply within 72 hours. Pricing requests may take longer depending on doctor availability and case complexity.

To complete the form, please click "I agree to the terms" before clicking “Send inquiry to Hospital”

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