fuda kr ft hospital Guangzhou

Your position:FUDA Hospital >>Kontakt

Anmodning om konsultation (Request for Consulting and Making a Reservation)

Udfyld venligst nedenst ende formular. Anmodningen skal sendes 5 dage inden ankomst til FUDA. Konsultation er gratis. Eventuelle dokumenter mv. bedes sendt til consultation@fudahospital.com.

Vi kontakter dig hurtigst muligt.

(Kindly fill in the form below. The reservation must be made 5 working days in advance of your arrival at hospital. Consulting is free of charge. If there’re documents, please send to consultation@fudahospital.com, we will contact with you as soon as possible. )

Information om patienten (Tell us about the Patient)

Navn [Name]:
Kontaktperson (tilknytning) [ Contact(Relation)]:
K n [Sex]:
Alder [Age]:
Pasnummer [Passport Number]:
Nationalitet [Country]:
Email address:
Telefonnummer [Telephone number]:

Beskriv venligst patientens nuv rende sygdomstilstand og symptomer (p engelsk)
Please give us the Current Medical Conditions /Symptoms:

Beskriv venligst patientens sygdomshistorie (p engelsk):
Please give us the Medical History:

Bem rkninger Remarks: