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Booking Online
You can now make an appointment online to see our doctor. It is easy to use and hassle-free.
Just fill in your details and your preferred date for the appointment on this page,
and our staff will contact you by the next working day to confirm.
*
Title
Title
Mr.
Mrs.
Ms
*
First Name:
*
Last Name:
Name of Health Insurance:
Home Address ::
*
Address:
Town:
Street:
Country:
--select country--
United Kingdom
United Kingdom, Channel Islands
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaidjan
Bahamas
Bahrain
Banglades
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian O. Terr.
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Buthan
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep.
Chad
Chile
China
Christmas Island
Cocos (Keeling) Isl.
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Estonia
Ethiopia
Falkland Isl.(Malvinas)
Faroe Islands
Fiji
Finland
France (European Ter.)
France
French Southern Terr.
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain (UK)
Greece
Greenland
Grenada
Guadeloupe (Fr.)
Guam (US)
Guatemala
Guinea Bissau
Guinea
Guyana (Fr.)
Guyana
Haiti
Heard & McDonald Isl.
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazachstan
Kenya
Kirgistan
Kiribati
Korea (North)
Korea (South)
Kuwait
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (Fr.)
Mauritania
Mauritius
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland Antilles
Netherlands
Neutral Zone
New Caledonia (Fr.)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Isl.
Norway
Oman
Pakistan
Palau
Panama
Papua New
Paraguay
Peru
Philippines
Pitcairn
Poland
Polynesia (Fr.)
Portugal
Puerto Rico (US)
Qatar
Reunion (Fr.)
Romania
Russian Federation
Rwanda
Saint Lucia
Samoa
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
Soviet Union
Spain
Sri Lanka
St. Helena
St. Pierre & Miquelon
St. Tome and Principe
St.Kitts Nevis Anguilla
St.Vincent & Grenadines
Sudan
Suriname
Svalbard & Jan Mayen Is
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
US Minor outlying Isl.
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis & Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
*
Postal Code:
*
Nationality:
Address in Samui::
Hotel:
Appointment
*
Phone:
*
Date:
Date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Mobile:
*
Time:
09:00 AM
09:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 AM
12:30 AM
01:00 PM
01:30 PM
02:00 PM
02:30 PM
03:00 PM
03:30 PM
04:00 PM
*
Email:
*
Subject:
Do you need a hotel pick up?
We will send you the pick up time --
Yes
No
*
Detail:
-
Bangkok Hospital Samui 57 Moo 3, Thaweerat Phakdee Road, Bophut, Koh Samui , Suratthani 84320
Tel: 0-7742-9500 Fax. 0-7742-9540
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