BIMC CARE Star

First Name*
Given Name*
Email*
Nationality*
Date of Birth*
Sex *
MaleFemale
Phone
Mobile
Address

Additional Family Member

Additional Family Member 1
Name
Date of Birth
Sex
MaleFemale

Additional Family Member 2
Name
Date of Birth
Sex
MaleFemale

Additional Family Member 3
Name
Date of Birth
Sex
MaleFemale

Additional Family Member 4
Name
Date of Birth
Sex
MaleFemale

Additional Family Member 5
Name
Date of Birth
Sex
MaleFemale

upload scanned copy KTP/KITAS/KITAP*

"BIMCare Star is available upon presentation of KTP/KITAS/KITAP or retirement visa"

BIMC Hospital Nusa Dua
The first hospital in Indonesia with accreditation from Australian Council on Healthcare Standard International  (ACHSI)

Your Name*

Your Email*