Bangkok Hospital Phuket  
Bangkok Hospital Phuket , Go to home page Bangkok Hospital Phuket , Login
 
     
Medical Consultation | International Medical Service | How to get here | BeHealthy BeHappy | Site Map  
     
About Us , Bangkok Hospital PhuketCenters & Clinics , Bangkok Hospital PhuketFind Doctor , Bangkok Hospital PhuketPatient Center , Bangkok Hospital PhuketPrograms & Packages , Bangkok Hospital PhuketContact Us Bangkok Hospital Phuket
Home » Patient Center » e-Payment » Appointment  
 
 
Patient Center
• Appointment
• E-payment
• Concierge Services
• Hospital Facilities
• Patient Services
Bangkok Hospital Phuket
 
Bangkok Hospital Phuket , Patients' Voices
Bangkok Hospital Phuket , Patients' Voices , Interview Interview Bangkok Hospital Phuket , Patients' Voices , Letter Letters
Bangkok Hospital Phuket , Patients' Voices , Email eMail /Forum Bangkok Hospital Phuket , Patients' Voices , Postcard Postcards
Bangkok Hospital Phuket
 
Bangkok Hospital Phuket , Special Packages
Bangkok Hospital Phuket , Special Packages , Wellness Puls Programs
Bangkok Hospital Phuket , Special Packages , Love Your Heart
Bangkok Hospital Phuket , Special Packages , Cancer Screening Advance
Bangkok Hospital Phuket
 
Bangkok Hospital Phuket , Highlight
Bangkok Hospital Phuket , Highlight , Payment Online by VISA and MasterCard
 
Bangkok Hospital Phuket , Highlight , Top Services
 
Bangkok Hospital Phuket , Highlight , Chivawattan Member Cards
 
Bangkok Hospital Phuket , Highlight , Patient Rooms Bangkok Hospital Phuket
Bangkok Hospital Phuket
 
Bangkok Hospital Phuket , Doctor Today
Bangkok Hospital Phuket , Doctor Today
Bangkok Hospital Phuket
 
Ask the Experts

 

 



Send your message...
 
Indicates essential information ( * Please inform )
 
 
 
 
Enter Code Show Now*
  
     
     
     
Patient Information    
     
Passport No./ID
  
     
Please Spectify Treatment*
  
     
Please Spectify appointment date and time*
   Day Month Year
     
     
Allergy to*
  
1. Drug Not Known None
   
Yes (Please specity)
     
   
2. Food Not Known None
   
Yes (Please specity)
     
   
3. Other Not Known None
   
Yes (Please specity)
     
     
First Name*  
     
Middle Name
  
     
Family Name/Last Name*
  
     
Gender*
  
Male Female
     
Date of Birth*
   Day Month Year
     
Age*
  
     
Marital Status
  
Single Married Divorced Widowed Priest / N
     
Occupation
  
     
Nationality*
  
     
Religion
  
     
Detail of document identification
  
ID Card Driver's License Passport
     
 
Others
     
 
No document because
     
     
     
     
Patient Contact Details    
     
HN. (Hospital Number)
   If you know
     
Present Address or Hotel name (in Thailand)
   Tel :
     
Permanent Address*
  
     
Tel. (Home)
  
     
Tel. (Office)
  
     
Tel. (Mobile)
  
     
E-mail*
  
     
How long have you been living at the present address?
  
Tourist/Short visit 1 Year 1-5 Years >5 Years
Permanent Resident
     
     
Emergency Contact Person   Name
 
Relationship 
     
    Tel
     
    Mobile
     
    E-mail
     
     
Insurance Company (if any)
   1.
     
    2.
     
Contract Company (if any)
   1.
     
    2.
     
     
   
 
 
 
 
 
 
Top
 
 
 
 

Job Opportunities | Outreach Clinics | Hospital Facilities | Insurance & Alliance | Contact Center | Significant Events
Link to www.ha.or.th (The Institute of Hospital Quality improvement & Accreditation) Prime Minister's Export Award
Link to www.phuketaesthetic.com (Plastic Surgery Center) Link to www.phuket-health-travel.com (Medical Tourism) Link to www.bkkdermato.com (Skin and Rejuvenation Center) Bangkok Hospital Phuket , Link Dental Center
Bangkok Hospital Phuket , Links Bangkok Hospital Phuket , Download Bangkok Hospital Phuket , Medical Tourism
   
  Bangkok Hospital Phuket, 2/1 Hongyok Utis Rd., Muang District, Phuket, 83000, Thailand. | Tel : +66 (0) 7625 4425 | Fax : +66 (0) 7625 4430
Local tel : 1719 (Only in Phuket, Chumphon, Krabri, Nakhon Si Thammarat, Phangnga, Ranong and Surat Thani)		  
  E-business : +66 (0) 7625 4425 Ext. 1280 | Fax : +66 (0) 7635 4056 | E-mail : info@phukethospital.com
 
 
© 2008. Bangkok Hospital Phuket. All Rights Reserved. Update : Today :