Pre-Registration & No Pre-payment for Surgery Abroad*

photo: Medical tourism in Thailand provides surgery abroad by American board certified doctors for 85% less

We know you already have a lot on your mind and are stressed out about your medical problem. We just want to help. We don't want to hassle you with lots of forms and questions and we aren't going to increase your financial burder with lots of fees before you even see a doctor.

photo: Medical tourism in Thailand provides surgery abroad by American board certified doctors for 85% less

Unlike some other USA medical tourists agencies that charge you US$195 to US$500 before you even get on a plane. We charge no “deposit”, no “facilitation fee”, no “records fee”, no “consultation fee”, not even a “flat fee”. We agree with the president of Thailand's Medical Council that “Medicine is about saving lives, not making money.” Medical-Tourism-in-Thailand.COM is here to make your life better.

photo: Medical tourism in Thailand provides surgery abroad by American board certified doctors for 85% less

The only thing we ask from you is that you provide us with accurate information for the doctors and hospitals who are going to help you. Be truthful & as detailed as possible. If you hide conditions or problems, you won't get an accurate price quotation because when the doctors discover them, your medical bill will go UP and your planned budget will go out the window.

These questions come directly from the hospitals. This information enables them to pre-register you prior to arrival so there will be no waiting, no delays, and no further form filling when you arrive. It also helps them diagnose your case and enables them to schedule your consultation with the doctor and the surgery that usual follows the next day.

Our only condition for helping is that you must provide the doctors with this information. We have a strict privacy policy which is pubished on this site. We ask for NO credit card information. We are not a travel agency selling plane tickets. We are strictly a medical tourism in Thailand facilitator.

Tell us about you so we can help solve your problem:

General Information

Full Name (as it appears in your passport):


Gender:    Male    Female

Nationality:


Passport or Travel Document Number:


Date of Birth:


Your Current Address:


Your Phone Number:


Your Email Address:


Weight:


Height:


Name of Persons to Contact in Case of Emergency:


Their Email Address:


Their Phone Number:


Their Address:


Planned Date of Surgery:


Date Flying Home:



Surgery Details

What Procedures Do You Require?


What Specific Results Do You Expect?


Questions for the Surgeon:

Medical Conditions

Diabetes or Blood Sugar Problems?    Yes    No

Thyroid Problems?    Yes    No

Heart Problems?    Yes    No
If yes, please explain:


Lung Problems (such asthma or other other breathing difficulties)?
    Yes    No
If yes, please explain:


Blood Pressure Problems?    Yes    No

Previous or Current History of Cancer?    Yes    No
If yes, please explain in detail:


Kidney or Liver Problems?    Yes    No

Have you had any traumatic experience during the past year such as a divorce, loss of a loved one or extreme stress?    Yes    No

Problems with Anesthesia?    Yes    No

Blood Disorders (such as bleeding or clotting problems)?
Yes    No          Are you HIV+ or do you have AIDS?     Yes     No

Have you been hospitalized, had surgery or received medical care within the past 12 months?    Yes    No
If yes, when?
If yes, for what reason?


Have you had weight loss surgery?    Yes    No
If yes, when?
If yes, which procedure did you have?
If yes, how much weight have you lost since your surgery?

Do you have any implants or any metal objects in your body?
    Yes    No
If yes, please specify:

Do you form keloids or have any difficulty with healing or scarring?
    Yes    No

Any Nervous Breakdowns or Depression?    Yes    No

Neurologic Problems?    Yes    No

Have you previously had any type of surgery?    Yes    No
If yes, list procedure(s) and date performed:


List all medications you currently take, including dosage:


List all vitamins or other nutritional supplements you take:


Any Allergies?    Yes    No
Food Allergies?    Yes    No
Drug Allergies?    Yes    No
If you have any allergies, please specify:


Have you ever taken an MAO inhibitor such as Nardil®, Marplan® or Parnate®?    Yes    No
If yes, when was your last dose?

Have you ever taken an anticoagulant such as Coumadin®, Heparin ® or a daily aspirin?    Yes    No
If yes, when was your last dose?

Have you ever smoked tobacco?    Yes    No
How much do you smoke now?
When was your last cigarette or tobacco product?

Do you drink alcohol?    Yes    No
If yes, what type, how much and how often?

Have you had or do you have any medical conditions not mentioned above?    Yes    No
If yes, please explain:


Additional info your doctor should know but we didn't ask about:


Are you taking any form of anti-depressants?    Yes    No

Have you made yourself aware of the risks involved in the the medical treatment you want?    Yes    No

Have you made yourself aware of all the possible complications that can occur from the medical treatment you want?    Yes    No
Have you read the article: “Complications of Surgery”?    Yes    No


For Women

Do you take birth control pills, any hormone replacement medication or use a hormone patch?    Yes    No

Are you pregnant?    Yes    No

Are you planning any more pregnancies?    Yes    No

When did you last deliver a baby (month and year)?
When did you last breast feed (month and year)?

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