Name:
Surname :
Age :
Email :
Mobile number :
Country:
ArubaAfghanistanAngolaAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBotswanaCentral African RepublicCanadaSwitzerlandChileChinaCôte d’IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiFranceMicronesia, Federated States ofGabonUnited KingdomGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndonesiaIndiaIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People’s Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaMozambiqueMauritaniaMauritiusMalawiMalaysiaNamibiaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People’s Republic ofPortugalParaguayPalestine, State ofQatarRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUruguayUnited StatesUzbekistanSaint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, U.S.Viet NamVanuatuSamoaYemenSouth AfricaZambiaZimbabwe
City:
Address:
Passport no :
Passport date of issue:
Passport date of expiry:
The needed surgery :
---درمان آلرژیدرمان انواع سرطاندرمانهای جراحی قلبدرمانهای داخلی قلبزیباییدندانپزشکیدیالیز خونجراحی های غیر اورژانسیجراحی های چشمزنان و زایمانکاشت مودرمانهای نازاییدرمانهای طبیعی و رلکسیشنجراحی های اعصابدرمان چاقیجراحی های ارتوپدیتوانبخشیانواع اسکن و تصویر برداریهای تشخیصیدرمانهای تغییر جنسیتبیماریهای پوست و موجراحی های ستون فقراتدرمان جراحت های ورزشدرمانهای بیماریهای خونکلیه و مجاری ادراریدرمانهای کاهش وزن
If the needed surgery or above information need more explanation
Upload image or file :
Needed touristic services :
Hotel :
3strar4 star5star
Number of room :
Number of bed :
Transfer services:
Date of travel :
Month:
ماه 1ماه 2ماه 3ماه 4
Depart:
Return:
How do you pay?
Paying a deposit of 30%, of the total package price by going to Abnoos Company’s office in your countryPaying a deposit of 30%, of the total package price into the account of Abnoos Company in your country and sending the deposit slipPaying a deposit of 30%, of the total package price by using international credit cardsPaying a deposit of 30%, of the total package price into account of Abnoos Company in Iran
Notice:
1-The rest of package price must be deposited into Abnoos Company account at least one day before being hospitalized. 2-The full price is according to the usual length of stay in hospital and hotel which are mentioned in the packages.It is obvious that the margin will be received if the length of stay increases.
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