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Enquiry Form

         Please fill out the following form and we will get back to you with a free quote and information for your treatment and procedure/s.
After receiving your form, a team member will send you an estimated quote and information for your surgery holiday. If you would like an exact price, as well as surgeon feedback as to what treatments/procedures is best for you, please send photos of the areas to be treated to: admin@thaicure.com
All photos and information will be treated in the strictest confidence between Thai Medical Vacation and the surgeon only.
After receiving a quote, please contact us for any additional information, and we encourage you to speak to the surgeon and past clients to enable you to make an informed decision.

Privacy: Thai Medical Vacation protects the information you give and pledge not to pass your details to any 3rd party, including hospitals, clinics or doctors, without your prior consent.

Please fill in all required fields

First Name
Last Name
E-mail
Phone
City
Where did you hear about Thai Medical Vacation?
Patient Information
Underlying Disease Yes , No If yes, Please specify
Drug/Food Allergy Yes , No If yes, Please specify
Smoking Yes No How many
Alcohol Drink Yes No How many
Excretion Normal Abnormal If abnormal, Please specify
Operation before Yes No If yes, Please specify
Migraine, Dizzy or faint Yes No If yes, Please specify
Family Information
Is there anybody in your family has the problem by this following :
Diabetes Yes No If yes, Please specify
Hypertension Yes No If yes, Please specify
Coronary Artery Stenosis Yes No If yes, Please specify
Cancer Yes No If yes, Please specify
Your Surgery Holiday:
Treatment Solutions & Packages:
(Discounts for multiple treatments.
Please select your primary treatment need and
specify additional additional treatments below)
If not on the list above or for additional
treatments & packages, please list here
About Yourself (Optional)
Do you have any other questions?