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관심콘텐츠
프린트

Appointment

Patient Information

Patient Information
* Required input Patient ID
(Revisiting Patient Only)
* Required input Name
* Required input Gender
* Required input Date of Birth
* Required input Nationality
* Required input Language
* Required input Country of Residence
Address in Home Country
* Required input Address in Korea
* Required input Phone Number
* Required input e-mail
Emergency Contact

Name :

Relationship with patient :

Phone Number :

* Required input Insurance Information

Appointment Details

Appointment Details
* Required input Symptoms
(Reason for Medical Appointment)
* Required input Medical Services Required
* Required input Preferred Date & Time

1st : / :

2nd : / :

Attach Medical Report
Attach Link
Attach Image

Before making a quick reservation, make sure to check the details of the collection and use of personal information.

1. Purpose of collection and use of personal information consent: For first-time visitors or non-member visitors to access quick appointment service
2. Personal information to be collected: (Required) Name, mobile phone number
3. Period of retention and use of personal information, etc.: To be deleted after 3 months
4. You have the right to refuse to consent to the collection and use of personal information. If you refuse, you will not be able to receive the quick appointment service.
5. Do you agree to the collection and use of personal information as above?