Your link to Global Healthcare
Contact Us
         Patient First Name       
         Patient Last Name                              
         Gender                                                                                       :
         Age                                                                                             :
         Full Name                                             
​Contact Details
  Mailing Address                                 
  E-Mail Address                                 
  Phone Number                                 
​About Your Medical Condition
If you are interested in learning more about how we can help you, please provide us the following general information about your needs. We will have one of our Case Managers get in touch with you to discuss details of how we can further assist you.
What sort of procedure(s) are you considering? (check all that apply)
 Why are you considering overseas treatment? (Check all that apply)
How urgent is your need?Immediate
​ Do you have a doctor who will help you obtain treatment overseas?
Have you discussed alternatives with a doctor?
 How do you intend to pay for your treatment?
Additional Information you want to share(if any)
Note:- It is not necessary to submit your medical records with your query. This will be arrange later. Do not copy/paste your medical report in the form above. We have a dedicated link to e-mail your medical reports confidentialy. Only authorized case managers have access to patient records.Patients record safety is our priority. Case manager will guide you at time of first communication where & how to send the medical records. 
MaleFemale
Cardiology
Cosmetic/Plastic
Gastroenterology
Neurology
Oncology
Orthopedics
Opthalmology
Dental
Other
Access to lower cost care
Access to high quality, personalized care
Access to treatments not yet available here
Ability to get treated more quickly
Better options for convalescent care
Anonymity
Opportunity to couple treatment with a vacation
Other
1-2 months
3-5 months
6+ months
Yes, I have a doctor
No, I need a doctor
No, I don't think I need a doctor
YesNo
Cash
Credit
Insurance reimbursement
Looking for Medical Loan
Other
Don't know
Please send me more information. I have gone through the Disclaimer statement and accept the Terms & Conditions