“Your Personalized Treatment Proposal”
Complete Clarity Before Your Treatment Journey Begins
“Include”
Recommended Hospital, .Recommended Doctor, Proposed Procedure/ Treatments Estimated Treatment Duration, Estimated Recovery Duration, Estimated Budget Range
“What Your Support Package Includes”Include:
Medical coordination Appointment scheduling Hospital communication Visa guidance Airport pickup/drop Accommodation assistance Translation support Recovery & wellness guidance Dedicated patient coordinator
“Important Information & Exclusions”
Emergency complications Additional medical procedures Extended hospitalization Personal shopping/travel expenses Insurance limitations Airline/visa delays
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
-
Month
-
Day
Year
Date
“Policies & Patient Acknowledgment”
Type a question
I have read the Privacy Policy
I understand the Medical Disclaimer
I accept the Terms & Conditions
I understand Haniawellcare acts as a facilitator only
I understand medical outcomes cannot be guaranteed
“Your Confidence Matters”
Type a question
Have all your questions been answered
Are you satisfied with the proposed treatment guidance?
Do you require additional clarification before proceeding?
“Patient Consent & Confirmation”
I voluntarily confirm that::
Type a question
I understand the proposed medical journey
I have received necessary clarifications
I understand the estimated costs and procedures
I willingly proceed with HaniaWellCare’s coordination services
Start My Treatment Journey”
Type a question
Confirm & Proceed
Submit
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