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Requesting an Appointment

All medical appointments can be made in person via phone, fax or e-mail for your convenience.

Business Hours

  • 8am to 5pm (Monday - Friday)

Contact Number

Patient Name
Patient`s Hospital ID Number (only for return patient)
Birthday (DD/MM/YYYY) ex)31 / 12 / 2013 Gender
Nationality
Alien Registration Number
(if available)
Passport Number
Korean National Health
Insurance
Referral from outside clinic (If No, please refer to Explanation on Insurance for Outpatients)
Other Health Insurance (If Yes, please refer to Explanation on Overseas Insurance for Outpatients)
Address in Korea
Permanent Address
Contact Number (in Korea) Telephone Number - -
Mobile/Cell Number - -
E-mail
Fax Number - -
Emergency Contact Name
Relationship with
the Patient
Telephone Number - -
Request Date
* If you want to see a doctor within 1 week, please call 031-219-4311.
Signs & Symptoms
Comments