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Patient Registration

Clients who are interested in receiving a complimentary surgery opinion from Dr Thanakom should complete and submit the following form.

The form should be completed as fully as possible, and you will be prompted for essential information. If you do not want to receive a surgical opinion, have a general enquiry or questions, please use the contact us page or send an email to info@dr-thanakom.com.

FREE ONLINE QUOTATION

Complete the online patient registration form now for a free complimentary surgery opinion from Dr Thanakom

Free Quote

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