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Secure Online Payment Form : Step 1

Only holding a credit card, you can pay your medical bills online 24/7!

 

Payer Information

This online payment is precise in every step; please fill in the full complete form. (*Required Information)

       
4
Payment Confirmation
 
Security Code *
Prefix *
First Name *

(Please input name as on passport/ID card)
Last Name *

(Please input name as on passport/ID card)
ID Card or Passport No *
The address can be contacted *
Country of Residence *
Province/State *
Zip / Post Code *
Email *
Confirm Email *
Mobile Phone / Phone can be contact

Terms and Conditions

  • You shall verify the accuracy of the information in every step on this online payment form.
  • You certify that the information on this payment form is complete, true and accurate.
  • Bangkok Hospital Phuket reserves the rights to deny any liability for the mistaken payment because of your declaration, or because ofyour illegal payment.
  • Your transaction may not be fully completed until the bank approves your payment.

*Please check this box to confirm that you have read, understood and agree to the above payment of Bangkok Hospital Phuket.

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Health Care in Thailand