K-MEDICAL TOUR - OPHTHALMOLOGY

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Ophthalmology Treatment
(Eye Doctor) Request

Form Submission

First Name*

Last Name*

Email Address*

Note: The provider will contact you via email with a great offer. Please ensure your email address is accurate.

Cell Phone Number

The provider may send you a text message regarding your reservation. Please note that message and data rates may apply.

Provider*

Provider A description here

Provider B description here

Provider C description here

Reservation Date*

Reservation Time*

If your preferred date and time are unavailable, the vendor may suggest alternatives.

Number of People for Treatment*

Specific Eye Treatment

Please specify the treatments you need (e.g., checkup, LASIK, LASEK, cataract surgery, glaucoma, dry eye treatment).

Your Location*

The provider will help you find the nearest high-quality eye clinic.

Do you also need a ride service for transportation?

Please type the characters*

This helps us prevent spam, thank you.

If you have additional questions about your request, feel free to contact the provider directly upon receiving their email.

We are an intermediary and not responsible for complaints,
incidents, refunds, or legal disputes for the services.

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