Payment Form

For your convenience, Bangkok Hospital Phuket arranges your online hospital bills for you and your beloveds. We accept MasterCard, Visa.

"*" indicates required fields

1. Payer Information

Please input name as on passport/ID card.

2. Payment Detail

Pay for Treatments / Operation / Deposit

3. Patient Information

Please input name as on passport/ID card.

(Please indicate, if applicable)
(Please indicate, if applicable)
DD slash MM slash YYYY

4. 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 of your illegal payment.

Your transaction may not be fully completed until the bank approves your payment.

This field is for validation purposes and should be left unchanged.

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From Bangkok Hospital Phuket