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원목활동 / 국제성모병원 내에서  원목실에 대해서 안내해 드립니다.

To make an enquiry or an appointment with our specialists, please complete the online or PDF file of the International Patient Information Form below and send us via email.
(*) Denotes mandatory fields.


Reservation
MAKE AN ENQUIRY
Inquire for  Myself    Friends/Relatives
Personal Information
Patient’s Name(*)
Gender(*)  Male    Female
Date of Birth(*)
Nationality(*)
Passport Number
Passport Expiration date
Country of Residence
Certificate of alien registration No.
Telephone No.(*)
(including country code)
Mobile No.
(including country code)
Fax No
Email(*)
Diagnosis
Previous medical history
(Hypertension, Diabetes,T uberculosis, Hepatitis, Surgery, Medication,etc)
Patient's Current Medical Conditions / Symptoms
Preferred Appointment Period
From : DD/MM/YYYY To : DD/MM/YYYY
Travel Plan
Date of Arrival in Korea
Flight No
Length of stay
Accommodation Request
International Patient Information Form
Send form to :
International Healthcare Center
Catholic Kwandong University
International St.Mary’s Hospital
25, 100 Beon-Gil, Simgok-Ro, Seo-Gu, Incheon Metropolitan City, 22711
Republic of Korea
Tel : +82 32 290 2652/2658(English)
+82 32 290 2653/2656(Russian)
+82 32 290 2654/2655(Chinese)
Fax : +82 32 290 2660
E-mail : ish2014feb@gmail.com