Please complete the form below and we will respond to your request asap.

If you are requesting for a same-day appointment (subject to doctor’s availability), please contact our call center at +62 361 3117311 or +62 361 484748.

MEDICAL DETAIL
If the date you want is not available, please contact our call center at +62 361 3117311 or +62 361 484748.
PATIENT INFORMATION
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DOCUMENTS UPLOAD
You may attach reference letter from your doctor, or any documents regarding the medical attention you need.
 

Please DO NOT use this form to send personal information, such as identity numbers, bank account information, passwords, or any other sensitive informations.

If you have any compliment or complaint about BaliMéd Hospital please call our call center at +62 361 3117311 or +62 361 484748.