REGISTRATION OF INTERNATIONAL PATIENT DEPARTMENT

Patient profile

Last Name*

Name*

Marital*
marriedsingle

Gender*
femalemale

tell*

Pass-Number*

born-city*

Education

Weight

Height

Home-Address*

email

Emergency contact number*

اDisease information

Cause-of-pain*

Date-of-hospitalization

Hospitalization-history*
YesNo

Cause-of-hospitalization

Date-of-surgery

History-of-surgery*
YesNo

History-of-surgery

Name-of-specific-disease

Name-of-specific-disease* ، ...
YesNo

medicine

History of taking certain drugs*
YesNo

medical-allergy-name

medical-allergy*
YesNo

5 Star Hotel

Price: ... $

transfer
The above fee is per night including breakfast
The cost of lunch and dinner and the use of additional facilities (store, atelier, coffee shop and restaurant) to
It is the responsibility of the patient.

Medical Guesthouse

Price: ... $

transfer
Medical guest house equipped with medical beds and monitoring depending on the doctor's diagnosis and needs
Patient
Nursing visit to the patient's bed
Misting and disinfection and daily monitoring, Internet
Telephone medical consultation support
Sampling tests and physiotherapy in case of patient's need and request
Services at the guest house are charged separately.

Selective diet
Low fatVegetarianDiabeticLow salt

Name of allergenic food

Food allergy
YesNo

book a ticket

Return ticket date

Mehrgan is responsible for that

Ticket reservation date

The ticket from the origin to Tehran is the responsibility of the patient, from Tehran to Kerman is the responsibility of Mehrgan

Description

IPD comprehensive medical visit
Basic screening according to WHO guideline, global standard
including chest x-ray, echocardiogram, mammography, pap smear, test
Laboratory tests to control blood sugar, blood, thyroid fat
All prostate at the discretion of the relevant doctor

Health package

Price :...

Description

Expert consultation of specialist doctors depending on the type of diagnosis
Sickness
endoscopy
colonoscopy
CT Scan
Advanced testing and other services

Advanced package

Price :...

Description

Dermatologist visit
Beauty services, mole removal, filler injection, botox injection,
Skin cleansing, angularization, laser, hair transplant
skin rejuvenation

Skin, hair and beauty package

Price :...

Description

Dentist visit
OPG
crime
implant
composite
laminate

Dental package

Price :...

Description

Clearing
Eyebrow and eyelash fibrosis
Shortness and hair color
Vitamin therapy
keratin
permanent oven
Permanent smoothness
Manicure and pedicure
Bath with traditional massage
Jacuzzi and massage pool

Hairdressing package for women

Price :...

Registration of International Patient Department

Ticket and accommodation reservation form

for the patient’s companion

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