Skip to content
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
联系我们
Online Registration
Please fill in English
Documents required: Please prepare a photocopy bio data page and sign (you can use your mobile phone to take pictures) Please upload the picture at the end of this page.
EN Online Registration
If you are human, leave this field blank.
---Allergy---
Allergy: Have you any drug or food allergies?
*
No known allergy
Yes
If yes, please specify
*
---Patient Information---
Title
*
Mr.
Mrs.
Ms.
Miss
Master
Other
Other
Name
*
Middle name
Last name
*
Date of Birth (DD/MM/YYYY)
*
Age
Sex
*
Male
Female
Marital Status
*
Single
Married
Other
Other
Nationality
*
Religion
Christian
Catholic
Sikh
Buddhism
Islam
Hindu
None
Other
Other
Passport No./ Identify card No.
*
Primary Language
*
---Address in Thailand---
Are you currently in Thailand?
*
No
Yes
Where do you stay?
*
Hotel
Apartment/Condominium
Address
*
Zip code
*
Hotel name
*
Room number
*
---Permanent Address---
Permanent address
*
Country
*
Zip code
*
---Contact---
Country code
*
Contact number/ Telephone.
*
Do you have Thai contact number?
*
No
Yes
Thai contact number
*
E-mail address
*
---Emergency contact person---
Next of kin name
*
Relationship to patient
*
Phone No.
*
---Signature---
Signature
*
Clear
---Upload passport with your signature---
Your Passport (Please photocopy bio data page and sign)
*
Click here to upload (Maximum size: 6MB)
Choose File
档案上传限制：6 MB
Submit
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
联系我们
登录
Newsletter
登录
用户名或电邮地址
*
密码
*
登录
记住我
忘记密码？
