Get A Detailed Case Review & Second Medical Opinion

Kindly fill the form below to submit a second medical opinion request at Bumrungrad International Hospital.

Second Medical Opinion Medical Details

Medical Details

Medical condition

Recent medical reports (you can upload multiple reports)

Brief description of medical condition

Preferred hospital

Second Medical Opinion Patient Details

Patient Details

Full name (as on passport)

Gender

Date of birth

Email address

Phone number (include country code)

Nationality

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