MedBridgeNZ:
VIP Health Screening Intake Form

To help us match you with the perfect screening package and secure your priority appointment at our partner hospitals in China, please complete this brief assessment.

Your information is strictly confidential and used solely for hospital coordination.

Section 1: Basic Information

First Name (as per Passport)

Last name (as per Passport)

WhatsApp / Phone Number

Age

Biological Sex:

Nationality

Section 2: Your Health Goals

Do you have any known medical conditions or a family history of specific illnesses?

Section 3: Travel Logistics

Estimated Travel Dates to China (Start Date) required

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Estimated Travel Dates to China (End Date) required

Preferred Date for the Health Screening required

Will you require any additional assistances

Section 4: Acknowledgment & Priority Booking Fee

I understand that MedBridgeNZ is a medical concierge service and does not provide medical advice, diagnosis, or treatment. The $49 USD fee is for priority booking and logistics coordination.

Upon successful payment, our medical concierge team will reach out within 24 hours to confirm your priority booking and discuss your next steps

MedBridgeNZ: VIP Health Screening Intake Form

Section 1: Basic Information

Section 2: Your Health Goals

Section 3: Travel Logistics

Section 4: Acknowledgment & Priority Booking Fee

MedBridgeNZ:
VIP Health Screening Intake Form