Online Registration
Please fill in English
Documents required: Please prepare your passport picture, COVID-19 screening test and upload the picture in this page.
For who received COVID-19 Vaccine, please prepare COVID-19 vaccine certificate picture
ASQ : EN New Patient registration
---Covid-19 Screening assessment---
Hotel of Alternative State Quarantine name
*
COMO Metropolitan Bangkok
Courtyard by Marriott Bangkok
Evergreen Laurel Hotel Bangkok
Holiday Inn Bangkok Silom
Le Méridien Bangkok
Mercure Bangkok Sukhumvit 11
Novotel Ibis Styles Bangkok Sukhumvit 4
Pullman Bangkok Hotel G
Rembrandt Hotel & Suites Bangkok
Shangri-La Hotel Bangkok
BNH Hospital
Flight Number
*
Which country do you fly from?
*
Arrival Date
*
Arrival Time
*
00:00
00:15
00:30
00:45
01:00
01:15
01:30
01:45
02:00
02:15
02:30
02:45
03:00
03:15
03:30
03:45
04:00
04:15
04:30
04:45
05:00
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05:45
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06:45
07:00
07:15
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07:45
08:00
08:15
08:30
08:45
09:00
09:15
09:30
09:45
10:00
10:15
10:30
10:45
11:00
11:15
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11:45
12:00
12:15
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12:45
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20:45
21:00
21:15
21:30
21:45
22:00
22:15
22:30
22:45
23:00
23:15
23:30
Do you experience any of the following respiratory conditions in the last 14 days?
Cough
Sore throat
Nasal Congestion
Not smell/Anosmia
Respiratory tachypnea, Shortness of breath, Dyspnea
Do you have a history of fever detected?
*
No fever
Body temperature ≥ 37.5°C
Have history of fever
Have you been confirmed COVID-19 infected?
*
Never
Yes, I have
When was diagnosed?
*
How are they treated?
*
Treated at home
Admitted in hospital
What is your medical history?
*
None of the medical history/Don't have any disease
Dyslipidemia
Coronary artery disease (CAD)
Diabetes
Renal Failure
Hypertension
Other
Please specify
*
How is your diabetes control?
*
Not control
Diet control
Insulin Injection
Take medication
Do you need dialysis?
*
No
Yes
Do you smoke?
*
Yes, I smoke
No, I don't smoke
Do you drink alcohol?
*
Yes, I drink
No, I don't drink
Do you currently taking any medicine?
*
No, I don't
Yes, I do
Please specify medicine name
*
How many hours of sleep do you need?
*
Do you need to take sleeping pill?
*
No, I don't
Yes, I do
Please specify sleeping pill name
*
Health care coverage / Social security (contracted hospital)
For social security : Would you like us refer you to contracted hospital ?
Yes
No
The destination after 14 days of quarantine, such as hotel name and etc.
*
COVID-19 Screening consent
*
I agree to do COVID-19 screening test
Please attach file for the COVID-19 test report
Click here to upload (Maximum size: 6MB)
Choose File
Maximum upload size: 6MB
Have you ever receive Covid-19 vaccination?
*
Yes
No
Vaccine's name
*
How many doses did you receive?
*
1
2
1st Dose date
*
2nd Dose date
*
Please attach file for the COVID-19 vaccination certificate
Click here to upload (Maximum size: 6MB)
Choose File
Maximum upload size: 6MB
If you are human, leave this field blank.
Next
你的旅程
1. 试管婴儿前期检查
如何在体外受精前准备
Pregnable 培孕宝
2. 体外受精过程
试管婴儿流程指南
试管部门医生&实验室
试管婴儿部门费用
3. 前往泰国
在線預訂
BNH服务
BOOCS健康疗法
儿科
保育室
網上商店
泰国 BNH 医院
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