Home Contact Us About Us Get an Email Quote Prices Business & Self Insured News Form Submission
 
   

Patient Information Form

First Name  
Last Name  
Address Line 1  
Address Line 2  
City  
State/Province  
Zip/Postal Code  
Country  
Daytime Phone  
Evening Phone  
Email address  
Date of Birth     Weight  Height
List all Medications:  
Past Surgeries & Dates
General Health
When should
treatment begin?		  
Will you need
financial assistance?		  
Type of procedure   
Specify procedure  

Please provide any additional information that we should know to help us connect you with the the most experienced Physicians and/or Surgeons

 

How did you hear
about us?

For Security, please enter the word Save   



JFSchafer@aol.com

Note: Your information is held within a Secure Server that we manage ourselves. It will never be sold or distributed to anyone under any circumstances. We are not medical providers... we ARE Medical Tour Operators, and it is our role to put you in direct contact with some of the most qualified Surgeons and Physicians in the world, practicing at JCI Accredited Hospitals that are all rated equal to, or better than medical facilities in the USA... and save you up to 70% in the process. 

Once YOU have interviewed and selected the overseas provider that you are comfortable working with, we then organize all of the details involved in that trip. Flights, accommodation, transportation, meals, sightseeing, around your Medical Procedure, and assure that all pre-surgery, surgery, and post surgical requirements are performed perfectly. The procedure is only one component of traveling out of the country... pre and post surgical care, along with rehabilitation and follow-up are equally (or sometimes even more) important than having a successful procedure, and Global Surgery Providers makes sure that every detail is taken care of perfectly so that you return having had an overall exceptional experience !
This is what we do...

 

International Medical and Surgical Procedure, Serving Medical Tourism Patients with Savings up to 70%

 
 

          International Surgical Procedures Costa Rica overseas surgery saving 70% quality surgeons and  world class medical facilities  - Global Surgery Network voted # 1
          Copyright (c) 2009 Global Surgery Providers, Inc. All rights reserved. | Privacy Policy g