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Appointment Request for International / Foreign Patients

Please read carefully before submission:

  1. All fields are mandatory.

  2. For New Patients: After submitting the form, email the following documents to feedback@oasisindia.in:

    • Previous medical reports

    • A clear soft copy of the patient's passport

  3. For Returning Patients:After submitting the form, email the following documents to feedback@oasisindia.in:

    • Genome medical reports (with Registration Number)

    • A clear soft copy of the patient's passport

  4. For All Patients:Please also include a clear soft copy of the attendant’s passport, if applicable.

Details of the Patient

Surname*
Given Name*
Gender *
Date of Birth *
Nationality*
Passport No*
Address in Native Country *
Address in India *
State *
City / District *
Pin Code *
Contact Number (In Native Country) *
Contact Number (in India)
Email ID *

Details of the Treatment

Diagnosis/Proposed Treatment*
Name of Doctor*
Department (Speciality)*
Cost of Treatment (Rs.)*
Duration of Treatment in Hospital (days)*
Tentative duration of stay in Hospital (days)

Details of Attendant -1

Surname*
Given Name*
Gender*
Date of Birth*
Nationality*
Passport No*
Address in Native Country *
Address in India *
State *
City / District *
Pin Code *
Contact Number (In Native Country) *
Contact Number (in India)
Email ID *
Relationship with the patient*
Add More Attendant

Submit Details to Request A Callback