BWS Agency – Stockholm Medical Office

BWS - Request of doctor's visit

Patient Name *

First

Last

Swedish Social security number (if applicable)

DOB (date of birth) *

Patient Phone

Address (Temporary in Sweden) *

Address Line 1

City

State / Province / Region

Reason of doctor's visit *

Type of visit *

At one of our clinics (SEK 1500)
Doctor comes to the patient (SEK 5000)

Time of appointment *

ASAP
Next day
Contact BWS email about appointment

Date / Time - vessel arrival to Stockholm *

//Date

Time

Date / Time - vessel departure from Stockholm *

//Date

Time

File Upload (if needed)

Contact person - BWS

BWS Contact Person *

First

Last

Email *

Name