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EWHA WOMANS UNIVERSITY MEDICAL CENTER

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Request an Appointment

Request an Appointment

Request an Appointment
Registration no.
(Revisiting patients only)
Name of the Patient
Sex Male   Female
Date of Birth
Nationality
Passport no.
Name of Medical Insurance Company
Language
Address in Korea
Address Overseas
Contact Details in Korea
Home Tel :
Mobile Phone :
Fax :
E-mail Address :
Emergency Contact
Name :
Relationship with Patient :
Telephone Number :
Date of examination and symptoms
Symptoms/
Medical services required
Comments