international medical center Appointment

international medical center

Appointment

Daegu Fatima Hospital ID Number (Only for registered patients)
* Name
(First/Middle/Last Name)
*Gender Male Female
*Date of Birth
Korean ID Number -
*Nationality
*Language
*Phone (In Korea)
*Email Address
*Permanent Address
*Medical Tourism Yes No
*Passport Number
*Passport Expiry Date
*Preferred Appointment Date
*Diagnosis/Symptoms
(Please be specific)
Special Comments
*Passport Upload

Please scan your passport and upload (5MB Within)

*Test Results Upload

Please upload your paper to scan result (5MB Within)

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