Book now

Patient Information

Name

Nationality

Phone Number

Email Address

※ We will send notices and confirmations to your email
so please make sure to fill in your correct email address

Gender

Female Male

Add face photo
(Front,Half-side,Side)

Add File +

Request

Policy Agreement & Note

I agree to all of the following

[Required] Agreement of personal information provision for service use and reservation

[Optional] Agreement to promotion & marketing usage

※ There will be an additional fee if you receive a consultation with our representative doctor instead of our deputy representatives. ※ If you only book for a consultation, a separate consultation fee will be charged. If you receive a same-day treatment, an additional consultation fee will not be charged. ※ A reservation fee may be added depending on the treatment.

Patient Information

Policy Agreement & Note