Thank you for your interest in Medera Global Health for your healthcare needs.  In order to best assist you, please complete the below form.  Once submitted,  international patient team will promptly contact you. 

Please Note: This form is intended for non-emergency appointment requests from international patients. If you are experiencing a medical emergency, please contact your local emergency services or go to the nearest emergency department immediately.

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Your Name *

First

Last

Email Address *

Phone Number *

Country / Region of Residence *

Passport Issuing Country / Region *

Health Information

Gender *MaleFemaleOtherPrefer not to say

If you selected Other, please specify.

Date of Birth *

What health concerns are you currently experiencing? *

Are you currently receiving any form of treatment? *NoYes

If yes, please provide detailed information.

Do you have health-related documents you can provide? *— 选择选项 —YesNo

If yes, please upload your documents.

Drag & Drop Files, Choose Files to Upload You can upload up to 9 files.

Service Preferences

What is your preferred contact method? *

• Email
• Phone
• WhatsApp

What type of support would you like to receive? *

• Health information consultation and resource matching
• Appointment coordination for medical in China
• Flight and hotel arrangements
• Visa assistance and pre-travel preparation
• On-site reception and accompaniment in China
• Translation and organization of medical documents
• Support for accompanying family members in China
• Post-visit follow-up
• Other

treatment? to contact

If you selected Other, please specify.

When do you plan to travel to China? *

What is your estimated budget for your health check or healthcare journey in China? *

Privacy Policy *

• I have read and agree to the Privacy Policy, and I understand that this form is for initial inquiry only. *

Verification Code *

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