Preferred Appointment

Option 1 *

Option 2

(optional)

Note: This schedule is based on normal doctor clinic hours. As there may be changes to the schedule from time to time, please wait for our representative to confirm your appointment timing.

Medical Concern or Request *

Attach

Any document you can provide us would be helpful.
(.jpg, .png, .pdf, -less than 2 MB in size)
To remove the attachment, please click 'Browse' and then 'Cancel'.

Patient Information

First Name *

Last Name *

Date of Birth *

Gender *

Male

Female

Country of Residence *

Nationality *

Email *

Confirm Email *

Primary Phone Number *

Visited Bumrungrad before?

Yes

Hospital Number (HN)

Do you need interpretation?

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 *

Travel Plan

Need accommodation hotel?

Yes

See special hotels rate for Bumrungrad Hospital

Greeting from Business Center,
Bumrungrad International Hospital.

I would like to book a 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 *

Night(s)

Number of Room(s)

Special Request

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.

I do not want to book a hotel (Please be informed that no hotel booking will be made.)

By submitting this appointment form, I agree that:

Making an appointment on this website with a Bumrungrad International hospital physician is for scheduling only. Bumrungrad International, its employees, any physician or clinician with whom an appointment has been made by use of this website has not agreed to provide the undersigned with any medical advice, diagnostic or therapeutic procedure until the undersigned has registered in person at Bumrungrad International hospital.
For the hotel reservation process, when the customer submit the information for hotel reservation, the information will be sent directly to the hotel chosen by the customer to make reservation which send only the information required to make hotel reservation, no information of customer treatment or diagnosis. However, Bumrungrad International Hospital acts only as a facilitator and a liaison between the customer and hotel. The hospital does not involve, in any way, with the hotel selection process; the consideration process; and is not responsible for the process. Therefore, Bumrungrad International Hospital will not be liable for any damages caused by this hotel reservation process.
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.