Inha University Hospital

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If you are interested in exploring the treatment options available outside your country. Inha University Hospital medical consultation program allows you to - consult with our specialist without getting on plan- to know your procedures, treatment and approximate cost. The purpose of the medical consultation program of Inha University Hospital is to provide information to patient so that an informed decision can be made in managing the patient’s health care needs. You can plan the best course of treatment with the confidence that your decision was well informed. This program aims to provide an alternative to traveling at this tome to Korea for care. However, should the patient travel to Inha University Hospital for care in the future, our coordinator will make all necessary arrangements.

By taking a few minutes to complete this form, you?or your representative acting on your behalf?can request medical consultation with our specialists. To expedite your request, please provide as much information below as you can. Because we respect your privacy, your information will not be shared with anyone outside of the hospital. Please complete the information below so that we may assist you as quickly as possible.? Please click on "Submit" at the bottom of the page to request the medical consultant. Forms also are available to mail or fax .Mandatory fields marked *

This form is not for urgent appointments or for appointments that you may need today. If you need emergency help, call 119 or go to your local emergency room.

1. Complete medical consultation

2. Once the medical consultation is received, our specialist will review the case.

3. After the medical consultation is reviewed, an international service coordinator will contact you shortly.

4. If you decided to get treatment at Inha University Hospital;
  Some patients, depending on their country, will need to obtain a visa to enter the Korea for medical treatment.   Our coordinators can assist with this process should you decide to seek care at Inha University Hospital.

5. The staff can advise you of the most convenient connections to reach Incheon International Airport, where an   Inha representative will meet you and your accompanying family members upon your arrival.

6. When you arrive, international care coordinator will accompany and help you with entire process of the   hospitalization and during your hospital stay.

Name


First Name	Middle Intial	Last Name
(If requesting an appointmentfor someone else.)

Title

Please indicate the best time to call you.

Phone Number


Country Code	Area Code	Phone Number
(If requesting an appointment for someone else.)

Relationship To Patient

* Patient's Name


First Name	Middle Intial	Last Name
(If requesting an appointment for someone else.)

* Title

* Sex

* Patient's Date of Birth


Month	Day	Year

Country

* Address


Number	Street	Apartment

City	State/Province	Zip/Postal code

Please indicate the best time to call you.

Phone Number


Country Code	Area Code	Phone Number
(If requesting an appointment for someone else.)

Email Address ( valid email required)

Reason for inquiry

My symptoms began around.

Please describe your treatment to date and your recommended next course of treatment (if applicable).

Please add any other information you believe would be helpful.

1. How did you hear about us?

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Note: We will make every effort to process your request as quickly as possible
Please check to be sure that all information in this form is correct before submitting.