Padma Care - Insider Medical Service and Advocacy Program

Welcome to Padma Care. We just need a few details to get your membership set up — this takes about 5 minutes. Have your passport handy for the photo upload. Your Personal Health Advisor will be in touch shortly after to get you fully set up.
PADMA CARE MEDICAL CONCIERGE

NEW MEMBER SIGNUP FORM
Your Name (New Member)*

First NameLast Name
Gender
Date of Birth

DayMonthYear
Place of Birth (Country)
This is required for patient registration (National law)
Mobile Phone / Whatsapp Contact*
Enter your full number with country code (no spaces needed)Format: +[0][0][0][0][0][0][0][0][0][0][0][0][0][0][0].
Email Address*
example@example.com
Your Home Address
City
or Town or Kabupaten or Kecamatan
Country
Padma Care bills monthly with a card on file — so you never have to prepay for medical services or worry about settling bills at the hospital. We accept all major credit cards (local and international). On the next screen, you'll securely authorize your card through our payment partner, Xendit. This is an authorization only — your card will not be charged until your service begins.

Complete information about our services can be found here: Terms of Service
Preparing to set appointments for you

Every hospital in this country will ask for an official photo ID before allowing us to book an appointment - your passport is the easiest way forward. Please fill details below.
Passport Number*
This is required for patient registration in our systems
Please share a copy of your passport*

Any appointment we make for you at a hospital will require this information. It makes it easier if we have it on file from the beginning (so you don't have to dig it out in an emergency).
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Emergency Contact & Family Information

We hope that you are never in a situation where you cannot make your wishes known, but it does happen and as a 'first call' provider of your medical care we want to be aligned with your intentions in this unlikely event.
Partner Or Emergency Contact Name

First NameLast Name
Relationship to Member
Email (if different)
example@example.com
Location
(If they live in a different place)
Partner Phone (Whatsapp)

Area CodePhone Number
Other people in your household that may access our service (e.g. kids)
Please include ages for reference
Anything else you'd like us to know?
For Relocating Members

Moving to Bali soon? Choose your start date and your membership activates when you arrive.
Subscription Start Date

DayMonthYear
Subscription Price
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PADMA CARE MEDICAL CONCIERGE

Preparing to set appointments for you

Emergency Contact & Family Information

For Relocating Members