Sehat Malaysia » Second Opinion

First Name

Last Name

Date of Birth

Gender

Blood Group

Height (Ft & In)

Weight (kgs)

Patient’s Contact Details

Phone No.

Address

Country

City

Select Your Category of Ailment

Choose a preferred city for your treatment

Pick a hospital where you would prefer your treatment

Scan and Attach your Medical Reports / X-Rays / MRIs / Prescriptions, etc.

Do you take birth control pills or any hormone replacement medication or patches?
- Yes
- No
Are you pregnant?
- Yes
- No
(Pregnant women must take a pregnancy test before departure as most pregnancies can disrupt surgery)

Second Opinion