Appointment

Patient Name *

Choose Treatment Type *

Choose Doctor *

Appointment Date *

Consultation type *

Date of Birth *

Where do you live? *

Gender *

Male Female Others

Email Address *

Phone Number *

Height *

Weight *

What country is your passport from? *

Language *

Please list any current medications

Do you drink alcohol or smoke tobacco? *

Yes No

List any current medical problems & allergies

List any past surgeries

What is your preferred method of communication? *

Email WhatsApp Phone Call

What type of medical procedure do you want? *

Upload Medical Record

Please upload your medical records, photos (for cosmetic procedures), or X-rays (for dental treatments). These are necessary for the doctor to provide you with an accurate treatment plan and quote.

What is your financial budget for the medical procedure? *

What is your preferred date of travel? *

Mon - Fri:	8:00 am - 8:00 pm
Saturday:	9:00 am - 6:00 pm
Sunday:	9:00 am - 6:00 pm