Please briefly describe the patient’s orthopedic concern and upload any available medical reports or imaging records. Based on the information provided, an MGH advisor will follow up with you regarding possible next steps, including remote orthopedic specialist review, in-person consultation in China, further examination, or treatment coordination.

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Your Name *

First

Last

Email Address *

Phone Number *

Country / Region of Residence *

Please enter where you are currently located, such as London, UK; Toronto, Canada; or Shanghai, China.

Passport Issuing Country / Region *

Who are you inquiring for? *— Select —SelfFamily / CaregiversFriendOther

If you selected Other, please specify.

Health Information

Gender *— Select —MaleFemaleOtherPrefer not to say

Please enter the patient’s gender.

If you selected Other, please specify.

Date of Birth *

Please enter the patient’s age.

What orthopedic health concerns are you currently experiencing? *

Please briefly describe the patient’s current orthopedic concern, such as pain, stiffness, numbness, weakness, limited movement, difficulty walking, or problems after a previous orthopedic surgery.

How long has the patient had these symptoms?

For example: 2 weeks, 6 months, several years, since an injury, since a previous surgery, or recently getting worse.

Has the patient already received a diagnosis from a doctor? *— Select —YesNoNot sure

If yes, please provide detailed information.

Does the patient already have X-ray, MRI, CT, or other imaging records? *— Select —YesNoNot sure

Please upload medical reports or related records

Drag & Drop Files, Choose Files to Upload You can upload up to 15 files.

If available, please upload X-rays, MRI, CT scans, medical reports, doctor’s diagnosis, surgery recommendations, or previous surgery records.

Service Preferences

What is your preferred contact method? *

• Email
• Phone
• WhatsApp

What type of support are you currently looking for? *

• I would like a remote orthopedic specialist second opinion first
• I would like to visit China for in-person consultation, examination, or treatment
• I am considering both options
• I am not sure yet and would like to speak with an advisor first

When do you plan to travel to China?

If you already have an estimated timeframe, please enter it here, such as August 2026, within the next 1–3 months, or not decided yet.

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

Additional notes

Please add any other information you would like us to know.

plan Information related

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

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