IMT Second Medical Opinion

Kindly fill the form below to submit a second medical opinion request to one of our partner hospitals.

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

By clicking submit you agree to allow us to share your information with the specialists at the partner hospital of your choice and you agree to our Terms of Use and Privacy Policy

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