New Patient Registration for Telemedicine
Allergy : Do you have any drug or food allergies? *

Patient Information

*
Sex *
Maximum upload size: 67.11MB
I acknowledge and do fully understand the Patient's Right Declaration. I agree that all of my health information treatment and investigation wound only be revealed with doctors, nurses and staffs who arhe involved.
I was accepted that,if I do not present any document for identify myself. All of my health report, laboratory result and other medical record will not be printed and verified by the hospital. And it will be available when I present my any identify document.
Estimated cost of service: 2,000 THB ( Doctor / Service / delivery charge ) NOT included the medicine and other medical charges.