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ABOUT US
MEET THE DOCTORS
BEAUTY
BLOG
CONTACT
Log In
Register
1:1 Video Consultation Form
1
Basic Information
2
Appointment Schedule
3
Medical Concern/Issue Details
Name
*
First
Last
Gender
*
Female
Male
Email
*
Email
Confirm Email
Preferred email is Google Gmail
Phone
*
Phone number with country code (e.g. +821011233232)
Additional Contact
mobile messenger ID (e.g. Whatsapp, Kakao, LINE)
Nationality
*
Needed for visa eligibility
Date of Birth
*
Next
Current Location (Time Zone)
*
Desired Appointment Time (Korea Standard Time)
*
Date
Time
Please provide at least 3 timeslots within 2 weeks, for appointment scheduling since doctor's availability is often limited. If you provide more timeslots, chances of confirmed video consultation becomes higher.
Desired Appointment Time (Korea Standard Time)
*
Date
Time
Desired Appointment Time (Korea Standard Time)
Date
Time
Desired Appointment Time (Korea Standard Time)
Date
Time
Desired Appointment Time (Korea Standard Time)
Date
Time
Desired Doctors/Clinics for Consultation (Optional, Up to 3)
If you have a specific doctors/clinics in mind, you can mention here.
Potential Travel Dates to Seoul
*
Does not have to be accurate, but tell us your best estimate.
Next
Desired Area of Procedure
*
Please describe your procedure/treatment needs as detailed as possible
Photo Details
Share relevant photos which will make the consultation more fruitful. Your photos will be securely shared only with the doctor.
Photo Details
Photo Details
Email
*
Name
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