HCMC Health Care Medical Clinic, Chiang Mai

Request an Appointment

To request an appointment with the doctor, please complete the form below and click on "Submit." A representative will call you within one business day to schedule an appointment.
This service is for non-urgent appointments only. If you have a medical emergency, please call: 08-27668672
* Required


	Patient Information
	Returning patient:		yes no
	* Last name:
	* First name:
	Middle name:
	* Date of birth:

	Contact Information
	Are you the patient?		yes no

	If not, what is your relationship to the patient?
	Name:
	Relationship:
	* Contact Number:
	Best time to call back:		(between 8:30am – 7pm., Monday to Friday)
	* Email address:		(example: yourname@example.com)
	Preferred contact method:

	Appointment Request Details

	Preferred day or days for your appointment:		Monday
			Tuesday
			Wednesday
			Thursday
			Friday
			Saturday 8:30am - 13.00 pm.


	Preferred appointment time:		Morning
			Afternoon
	* Date of Appointment:


	Briefly describe reason for visit:

	*Please Check I'm not a robot:

To speak to a representative about making an appointment, please call: 053-804405 from 8:30am – 7pm., Monday to Friday.