Bumrungrad Patient Inquiry Form

At IMT we want to make it easy for you to get treatment options and quality health care at Bumrungrad International Hospital in Bangkok Thailand.

Kindly fill the form below with your correct information to enable the specialists at Bumrungrad to provide you with the right treatment options within the shortest time possible.

All information and medical records will be treated confidentially.

    Get A Free Treatment Plan

    Fill the form below to get a free treatment plan from Bumrungrad International Hospital

    Appointment Details

    Upload your recent medical reports* (You can submit more to an IMT co-ordinator if need be)

    Patient Details

    By clicking submit you agree to allow us to share your information with the specialists at Bumrungrad International Hospital and you agree to our Terms of Use and Privacy Policy