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Corporate Service

IV Therapy & Injections

Dr Jirapat Suriyachaisawat

General Practitioner - GP Clinic

Dr Pimsupa Puthipiroj (Dr Pim)
Dr Phattheera Chauvachata (Dr Aye)
Dr Jirapat Suriyachaisawat

Women's Health

Dr. Chawapon Kidhirunkul
Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Dr Napalai Poorirerngpoom
Tanya Stockdale
Dr Sasiwimol Preechapornkul
Dr. Pokpong Pansrikaew

B2B Mordee Health Check

Dr Pimsupa Puthipiroj (Dr Pim)

Men’s Health

Dr. Chawapon Kidhirunkul
Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Dr Napalai Poorirerngpoom
Tanya Stockdale
Dr. Pokpong Pansrikaew

Children's Health

Dr Pimsupa Puthipiroj (Dr Pim)

Longevity

Dr. Chawapon Kidhirunkul
Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Dr Napalai Poorirerngpoom
Tanya Stockdale

Sexual Health

Dr Pimsupa Puthipiroj (Dr Pim)
Dr Phattheera Chauvachata (Dr Aye)

Vaccines

Dr Pimsupa Puthipiroj (Dr Pim)
Dr Phattheera Chauvachata (Dr Aye)

Diabetes & Blood Disease

Dr. Khemaporn Lertdetkajorn
Dr Tullaya Sitasuwan

Cancer

Dr Ployploen Phikulsod

Nutrition

Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Tanya Stockdale
Chaii Fongsai
Lhong Budhwongsopha
Emma Lund

Traditional Chinese Medicine & Thai Traditional Medicine

Dr. Witwasin Kakaew
Dr. Thipkrita (Fair) Thitipongpreeda

IVF and Family Planning Counseling

Dr Sasiwimol Preechapornkul
Dr. Pokpong Pansrikaew
Dr. Irada Wattanavitukul
Dr. Miranda Denison
Dr. Olivia Carelli
Dr. Nicole Poell
Dr. Stephanie Stefanelli
Dr. Panicha McGuire
Charles Wright

Physiotherapy, Sports Science & Performance Coaching

Dan Remon
Supapong (Boss) Juntharin
Ice Pornchaumsri
Handy Ong
Sandy Burchart

Health Insurance

Walter van der Wal

Navigate Thai Healthcare with Ease

Ace Bruel

Neuropsychological & Psychological Services

Dr. Irada Wattanavitukul
Dr. Sarunporn (Jay) Sirikietsoong
Dr. Ted Albrecht
Dr. Kayla Page
Dr. Jennifer Lai
Dr. Miranda Denison
Dr. Olivia Carelli
Dr. Nicole Poell
Dr. Stephanie Stefanelli
Dr. Panicha McGuire

Dr Jirapat Suriyachaisawat

Dr Pimsupa Puthipiroj (Dr Pim)
Dr Phattheera Chauvachata (Dr Aye)
Dr Jirapat Suriyachaisawat

Dr. Chawapon Kidhirunkul
Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Dr Napalai Poorirerngpoom
Tanya Stockdale
Dr Sasiwimol Preechapornkul
Dr. Pokpong Pansrikaew

Dr Pimsupa Puthipiroj (Dr Pim)

Dr. Chawapon Kidhirunkul
Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Dr Napalai Poorirerngpoom
Tanya Stockdale
Dr. Pokpong Pansrikaew

Dr Pimsupa Puthipiroj (Dr Pim)

Dr. Chawapon Kidhirunkul
Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Dr Napalai Poorirerngpoom
Tanya Stockdale

Dr Pimsupa Puthipiroj (Dr Pim)
Dr Phattheera Chauvachata (Dr Aye)

Dr Pimsupa Puthipiroj (Dr Pim)
Dr Phattheera Chauvachata (Dr Aye)

Dr. Khemaporn Lertdetkajorn
Dr Tullaya Sitasuwan

Dr Ployploen Phikulsod

Dr Jirapat Suriyachaisawat
Dr Nuttakul Lungkorn
Tanya Stockdale
Chaii Fongsai
Lhong Budhwongsopha
Emma Lund

Dr. Witwasin Kakaew
Dr. Thipkrita (Fair) Thitipongpreeda

Dr Sasiwimol Preechapornkul
Dr. Pokpong Pansrikaew
Dr. Irada Wattanavitukul
Dr. Miranda Denison
Dr. Olivia Carelli
Dr. Nicole Poell
Dr. Stephanie Stefanelli
Dr. Panicha McGuire
Charles Wright

Dan Remon
Supapong (Boss) Juntharin
Ice Pornchaumsri
Handy Ong
Sandy Burchart

Walter van der Wal

Ace Bruel

Dr. Irada Wattanavitukul
Dr. Sarunporn (Jay) Sirikietsoong
Dr. Ted Albrecht
Dr. Kayla Page
Dr. Jennifer Lai
Dr. Miranda Denison
Dr. Olivia Carelli
Dr. Nicole Poell
Dr. Stephanie Stefanelli
Dr. Panicha McGuire

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MedAsia Healthcare Complex, Level 9, Building 14 - Soi 5 Sukhumvit Rd, Khlong Toei Nuea, Watthana, Bangkok 10110
+66 064 553 9506 info@healthdeliver.asia

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Patient Details

First Name*

Last Name*

Contact Number / Email*

Hospital Number*

Date of Birth*

Passport / ID No. *

Country of Residency *

Nationality *

Normal Appointment

Medical Enquiry

Medication Refill

Appointment Details

Preferred Appointment Date/Time *

Preferred Doctor/Specialty *

Purpose of Appointment *

Specific Concern / Request procedure / Interest *

Available investigation / Result

(Attach the document)

Request for interpreter ( Specify the language ) *

Payment Method

Insurance

(Please attach front and back page of an insurance card)

Self-pay

Yes

No

Enquiry Details

Chief Complaint or Diagnosis *

Current condition/symptom *

History of Present Illness *

Medications, Allergies (drug, food, etc.) *

Updated Investigations

(Laboratories/imaging studies, e.g. x-ray, CT, MRI, biopsy result, etc.)

Source of information (relative, referral office, etc.)*

Specific concern / request procedure / interest*

Updated Medical Summary Report

(If possible not older than 2 months, typed-written and in English language, 6 International calendar dates)

Please specify whether the patient is in the hospital or not.

Yes

No

Medication Refill / Medical supply

Primary Doctor's name *

Update the condition after finishing the medication *

Name of the medicine / medical supply *

Quantity *

How to collect the medications (Pick up at Bumrungrad or shipping)*

The address in details with contact number (In case of shipping)

Refill requests are only ELIGIBLE if you have not missed more than ONE year of follow-up with our physician. In case of lost follow- up more than ONE year, we do recommend the patient/relatives appoint with our physician in person or Tele-consultation for consideration.

For International shipping

Please contact your local customs authorities and DHL for the local regulations and other details before starting the process because all the medicines that have been shipped from our hospital can't be returned back to our hospital.