Bangkok Hospital Samui | Samui Hospital | International Hospital Private, Medical Tourism,Koh Samui, Bangkok, Thailand

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Appointment

Bangkok Hospital Samui encourages you to request an appointment. If you need to request an appointment for your relatives, please complete this form and state that in 'comments'. Our customer support will contact you accordingly.

All fields marked with an asterisk (*) are mandatory


Your Appointment Information :
HN (Hospital Number) :	If you know
Your Name * :
Surname * :
Gender * :	Male Female
Nationality * :
Date of Birth * :	Day Month Year
Passport No./ID * :
Specialty * :
Preferred appointment time * :	Day Month Year
Time * :
Special request * :

Patient Contact Details :
E-mail * :
Tel (Home) * :
Tel (Mobile) * :
Present Address or Hotel name (in Thailand) :

Please enter code shown below. * :

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Bangkok Hospital Samui 57 Moo 3, Thaweerat Phakdee Road, Bophut, Koh Samui , Suratthani 84320

Tel:+66 7742 9500 Fax. +66 7742 9540