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  1. Step 01. Request an appointment
  2. Step 02. Review & Submit
  3. Step03. Finished

Our representative will respond within 24-48 hours after the confirmation

Urgent appointment : Please note this form is for regular appointments. For urgent appointment, please call the hospital at +82-2-3410-0200.

Request an Appointment

Appointment
*Consent for disclosure of personal information
Department
 
*Preferred Appointment
  • 1st
     
  • 2nd
     
  •   * ※ The date is a compulsory item of input information. Please select the date.    
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High-risk patients

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Referral

Are you currently admitted at another hospital? If yes, please give us the date of admission.
Attach
  • Medical Report
  • Image
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Travel Plan
  • Arriving in Korea
          Length of Stay  

Patient Information

* Necessary Input Information
Patient Information
*First Name
*Last Name
*Gender
   
*Date of Birth
*International insurance
 
 

*Nationality
*Korean national health insurance
   
*Domicile
   
Address in Korea
Permanent Address
*E-mail
Contact Number
  • Telephone Number
  • *Mobile Number
  • Fax Number
Relationship to the patient
               
Requesting Person's Name
Country
Address
City
State/province
Postal code
Primary phone Secondary phone
Fax Email
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