Medical Intake form

Please leave your contact details, and one of our Medical Trip Coordinators will reach out to you within 24 hours once you complete this form.

Thank you for choosing Hayakom!

For direct inquiries:

Email: support@hayakom.travel
Phone: +201024906992

Type of Medical Service NeededNames and track records of doctors will be provided before confirming your trip

Cosmetic Surgery

Dental Care

Wellness Check-up

Orthopedic Surgery

Cardiology

Oncology

Neurology

Gastroenterology

Ophthalmology

Fertility Treatment

Dermatology

Plastic Surgery

Other

Please select the preferred level of medical consultation for your treatmentYou can choose more than one

General Practitioner

Specialist (experienced, but not senior)

Consultant (highly experienced)

Upload any relevant medical reports here (optional)Relevant medical documents or reports to assist our medical consultants. Your health information is confidential and will be handled with the utmost care.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Are you interested in exploring Egypt's natural remedies and therapeutic environments?

YESNO

Healing Destinations in Egypt: Natural Remedies and Therapeutic EnvironmentsThese locations are popular for wellness tourism, offering natural remedies and therapeutic environments. Choose your destination .

Siwa Oasis : Known for its hot springs, therapeutic mud, and salt lakes.

Marsa Alam : Famous for its natural hot springs.

Aswan : Famous for its dry climate, which is beneficial for patients with respiratory issues and rheumatism.

Safaga : Known for its black sand beaches and mineral-rich waters, beneficial for skin and joint disorders.

Ain Sokhna : Known for its warm, mineral springs.

Helwan : Home to therapeutic sulphur springs, beneficial for skin and joint ailments.

Bahariya Oasis : Features hot springs with therapeutic properties.

Fayoum : Noted for its medicinal springs and lakes.

New Valley (El Wadi El Gedid) : Known for its hot springs and healing climate.

Al-Quseir : Notable for its therapeutic black sand beaches.

Who will be Traveling?

By myself

Couple

Family

Group

Number of Travel CompanionsTotal number of travelers

Size of GroupTotal Number of Travelers

Are you interested in tourism services as well? If yes, please choose your preferred activities and we will tailor the trip for you.* This field is required.

YESNO

Activities you would like to add to your trip.Desired Destinations : Our team will check the availability and timing for your request and get back to you soon. If it's available, we'll share the pricing details with you.

Safari

Shows / Theater

One of a Kind Expeditions

Biking / Buggy near the Pyramids of Giza

Camel with Panoramic Pyramid Views

Nile River Cruise with Felucca Sailing

Visit to Khan El Khalili

Rock Climbing at Wadi Degla Protectorate

Horseback Riding in the Desert

Kayaking on the Nile River

Hiking and Bird Watching at Al-Azhar Park

Visits to Mega Malls

Visit to Zoo / Africano

Wellness and Spa Packages

Underwater Adventures

Pyramid Skydiving Adventures

Farm-to-Table Experiences

Nightlife and Entertainment

Music and Dance Classes

Shopping and Souvenirs

Sand Skating

Cairo Tower

Street Food Tour in Downtown Cairo

Nilometer on Rhoda Island

Cairo Opera House

Al-Azhar Park

Naguib Mahfouz Cafe and Bookstore

Mohamed Ali Palace (Manial Palace)

Mamsha Masr

Walk of Cairo

Services that you need along your trip.

Airline Tickets

Accommodation

Comfort Stay Apartments

Rental Car

Airport Lemo

All-Inclusive resorts

VIP and Luxury Services

Event Coordinators

Dining Recommendations

Local Tips and Advice

Guided Tours

London Taxi

Type of Flight* This field is required.

Destination Airport in Egypt* This field is required.

Level Of Class* This field is required.

Departure Date* This field is required.

Date

Return Flight Date* This field is required.

Date

Oops! There is an error with the dates. Please adjust the return date to be after the departure date.

Preferred Airline

Level of Hotel accommodation

Luxury hotels (five star and other luxury establishments).

First class hotels and inns such as used on guided tours (four star and similar).

Villas Rentals (private rental properties with home-like amenities)

Apartment Rentals (private rental properties with home-like amenities)

Tourist class hotels and inns (three star and similar).

Simple hotels (bath on hall likely).

Check-In Date* This field is required.

Date

Check-Out Date* This field is required.

Date

Oops! There is an error with the dates. Please adjust the Check-in date to be after the Check-out date.

Number Of Rooms* This field is required.

Choose your essential Amenities for Rental

Fully Equipped Kitchen

Free Wi-Fi

Air Conditioning/Heating

Washer/Dryer

TV with Cable/Satellite

Private or Shared Pool

Parking Space

Bathroom Essentials

Linens and Bedding

Balcony/Terrace

Fitness Equipment

Workspace/Desk

Safe/Lockbox

Coffee Maker/Kettle

Iron and Ironing Board

Outdoor Furniture

Pet-Friendly Options

Preferred Hotel Brand

Are there any specific requirements for your accommodation?Please specify any special requirements for your accommodation, such as bed types, view preferences, amenities, accessibility needs, proximity to certain locations, and room features.

Payment Method Selection* This field is required.

Comments or Questions

Please leave your contact details, and one of our Medical Trip Coordinators will get in touch with you.

Name

Phone Number

Thank you for taking the time to complete this form and express your interest in medical tourism in Egypt with Hayakom.

Your submission will be received once you press submit, and someone from our team will get in contact with you within 12 Hours.

If you have any urgent inquiries or additional information to share, please feel free to contact us directly at

support@hayakom.travel

or call us at this number

+201024906992

Warm regards,

Hayakom Team