Cathay General Hospital

We Care Your Health

Location: Home > International Health Care Services

International Medical Service Appointment Request Form
Last Name:		First Name:
Sex:	Male Female
Date of Birth:	Year Month Day
Passport Number:
Address:
Telephone Number:	Home Office
Cell Phone Number:
Fax Number:
E-mail Address:

Medical issue you wish to consult specialist on:

Chief complaint / symptoms:

Notes:

Tel:886-2-27082121,ext. 1312 FAX:886-2-27082430

Cathay General Hospital, 280 Renai Rd. Sec.4, Taipei, Tel:02-27082121
The registered trademark is licensed by Cathay Financial Holding Co., Ltd..