Surgery Detail

Medical Condition

Surgery History

Attach picture

( please send the picture in 5 standard position )

Picture1 (front view) *

Picture2 (left side view 45 degree) *

Picture3 (right side view 45 degree) *

Picture4 (left side view 90 degree) *

Picture5 (right side view 90 degree) *

Picture6 (head tilt view) *

You can booking appointment via our website and send email to doctor before. Please pay deposit before do procedure via UOB bank (Thailand) or Western union

For UOB bank (Thailand)

Account name : Sununtika Chitvarin

Account number : 602 - 100 - 497 - 6

Swift code : UOVBTHBK

Or Western union or Paypal

Name : Sununtika Chitvarin

Thailand Or Paypal to

After deposit already please kindly send copy receipt to our clinic via the email and booking is confirm

E-mail :

Tel : (+66)-876883999