Medical Intake Form

We offer end-to-end support — from medical consultation and appointment scheduling to visa assistance, accommodation, and in-hospital support across major cities in China.

Please complete the form below to help us understand your needs. Our team will respond within 1–2 business days with a personalized quote and next steps.

1. Personal Information

First Name

Phone

Last Name

City of Residence

2. Medical Information

What is your current medical concern or condition?

Upload medical files (if any)

Upload File

Upload supported file (Max 15MB)

3. Service Preferences

Which services do you need help with?

Medical consultation matching

Appointment scheduling in Shanghai

Visa and travel coordination

Medical document translation

In-person interpreter / bilingual escort

Local accommodation booking

Airport or train station pickup

Other (please specify below)

Other needs:

4. Travel Preferences

Preferred travel dates (approx.)

5. Budget Range

How to Think About Your Budget

Medical treatment abroad can vary significantly in cost depending on your diagnosis, the treatment plan, and your travel preferences.

Please provide a rough estimate of your total budget so we can recommend options that are best suited to your needs. If you're unsure, just select “I’m not sure yet” — our team will guide you based on your goals.

6. Additional Notes

Is there anything else you'd like us to know?