(1)BBH General Consultation Form
Please provide the medical information. Medical team will review the document and provide the recommendation and treatment plan.
You can send the following files to info@bbhhospital.com.
- medical reports
- laboratory reports
- MRI, or X--ray 
- A short clip of patient.

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Patient First Name - Last Name *
Gender *
Date of Birth *
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Nationality *
Country of Resident *
Contact Person / Relationship with patient *
Contact Email *
Phone number/Whatsapp/Line *
Primary Diagnosis *
Date of Primary Diagnosis *
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Underlying diseases, secondary diagnosis or other diagnosis and their treatments. *
Chief Complaint *
Medical History - When where and how patient received treatments *
If accepted, when is your estimate treatment date? *
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What are the reasonable medical results the patient is hoping for? *
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