BASIC CARDIOVASCULAR SCREENING PACKAGE

Health Check Package Information

Full name*

Date of birth

Phone number*

Health check-up package *

Patient Information

Full name* Date of birth

Email Phone number*

Province/City *

District *

Ward/commune *

Address*

Specialties

Doctors

Examination date*

Morning/ Afternoon

Morning Afternoon

Reason for visit

Book for a foreigner (25% surcharge) Book for a relative