Sri Lanka | 2018/02/24 |

Request to Arrange Hotel Visit (Doctors` House Call Vist) :


  Name

:

 
  Email

:

 
  Contact No

:

 
  Country

:

 
  Address of the Hotel

:

 
 

Describe your Medical Problem

 

:

 
  Able to Communicate in English / Need Assistance of a Translator    
 

Any known Drug or Food Allergy

   
  Validation 10 + 6 = ?

:

 
  Email

:

assist@medassist.lk  
         
     
 
         
 
  • If you have more details or Images which describe your illness to sent to us , please forward your email to assist@medassist.lk
 
         
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