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  • Personal Information
  • Treatment Information
  • Service Information
  • Additional Service Information
  • Additional Service Information

Personal Information

Treatment Information

Choose the city you want to treat

Choose the city you want to treat *

Choose the city you want to treat

Choose the hospital you want to treat *

We do not have a contracted hospital in the city you are looking for. If you wish, you can specify us below.
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Choose the department you want to treat *

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Enter a description of your treatment

Choose the city you want to treat

Choose the date you want to treat *

Please select a hospital department

Geri
İleri

Service Information

Accommodation Information

Car Rental Information

Transport information

Additional Service Information

Başvuru Önizleme

Personal Information

Name: {{formVerileri.adSoyad}}

Email: {{formVerileri.kullaniciAdi}}

Telephone: {{formVerileri.telefon}}

Country: {{selectVerisiGetir(formVerileri.ulke)}}

City: {{formVerileri.sehir}}

Language Option: {{selectVerisiGetir(formVerileri.dil)}}

Treatment Information

City Selection: {{radioVerisiGetir(formVerileri.il)}}

Hospital Selection: {{radioVerisiGetir(formVerileri.hastaneKodu)}}

Section Selection: {{radioVerisiGetir(formVerileri.bolum)}}

Complaint: {{formVerileri.sikayet}}

History: {{formVerileri.tedaviTarihi}}

Service Information

Hotel Selection: {{selectVerisiGetir(formVerileri.otelKodu)}}

Hotel Selection: -

Automobile type: {{selectVerisiGetir(formVerileri.aracVites)}}

Automobile type: -

Segment Selection: {{selectVerisiGetir(formVerileri.aracSegment)}}

Segment Selection: -

Automobile Selection: {{selectVerisiGetir(formVerileri.aracKodu)}}

Automobile Selection: -

Aircraft Selection: {{selectVerisiGetir(formVerileri.ucak)}}

Aircraft Selection: -

Additional Service Information

Would you like to meet at the airport?: {{selectVerisiGetir(formVerileri.karsilama,"karsilama")}}

Would you like a VIP transfer?: {{selectVerisiGetir(formVerileri.vip,"vip")}}

Would you like a treatment assistant?: {{selectVerisiGetir(formVerileri.asistan,"asistan")}}

Do you want a touristic trip?: {{selectVerisiGetir(formVerileri.gezi,"gezi")}}

Do you want travel insurance?: {{selectVerisiGetir(formVerileri.sigorta,"sigorta")}}

Additional Service: {{formVerileri.ekHizmet}}

Application Completed



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