02 725 9595

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Pre-registration for new patients

*Important Notice : For new patient, please make your appointment in advance at 02 725 9595 or contact@manarom.com To speed up new patient’s registration process, please fill out the provided form, print the completed form then bring it together with your identification document on your first day at Manarom Hospital.

    The identification document is the obligation by law, without the document we will not be able to provide the treatment. Please bring following document(s) to our registration officer.

    • Adults over 18 years old

    Passport or Identification Card


    • Minors under 18 years old
    Passport or Birth Certificate
    Parent/Legal guardian’s presence and identification document


Fill out the form and print.
Please, give the completed printout to our registration officer.

Fill the form

OR

Enter your fax number to receive the form within 24 hours.


Send

OR

Enter your phone number, should you need us to contact you within 24 hours.


Send

Mental Health Services

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Day Program

Pre-registration for new patients

Mental Health Services