Nationality & country/city of residence
Phone number (with country code)
Please select your primary need:
General health check-up
Specialty disease treatment (Department: __________, e.g. Orthopedics, Cardiology, Dentistry, Ophthalmology, etc.)
Postoperative rehabilitation
Second medical opinion
Price and consultation process inquiry only
Traditional Chinese Medicine (TCM) experience
Estimated treatment budget range
Please select your expected outcomes:
Confirm diagnosis
Undergo surgical treatment
Conservative treatment / medication plan
Functional rehabilitation and recovery
Primary area of discomfort
Specific symptoms (e.g. pain, numbness, dizziness, weakness, etc.)
Symptom severity (pain scale 1–10, 1 = mild, 10 = unbearable)
Onset characteristics
Persistent
Intermittent
Worse at night
Worse with activity
Other
Impact on daily life / work
Previously diagnosed conditions
Past surgical history (please indicate date, procedure and hospital)
Drug / food allergy history
Chronic conditions (e.g. hypertension, diabetes, etc.)
Relevant examinations completed in your home country (e.g. CT, MRI, X-ray, blood tests, etc.)
Treatments received (e.g. medication, physical therapy, surgery, etc.)
Previous treatment effect & whether the condition has relapsed / worsened
Medical documents status
I have relevant examination reports, imaging files and medical records
I do not have relevant medical documents
Expected date of arrival in China
You may select multiple options:
Flight booking assistance
Airport pick-up and drop-off service
Hotel reservation assistance
Full-time interpretation accompaniment
Special dietary requirements (e.g. vegetarian, halal, etc.)
Other needs
I hereby confirm that all stated medical conditions and submitted medical documents are true and valid. I agree that the above information will be collected and used solely for hospital coordination and medical consultation, and will be kept strictly confidential. I understand that the initial online assessment does not constitute a final diagnosis. The specific treatment plan shall be subject to in-person consultation.