Appointments

Health Checkup Appointment

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Patient Information

Patient Information
Has the patient been in
Asan Medical Center?
First Name Last Name
Date of Birth
Gender
Nationality
E-mail Phone Number

Appointment Details

Preventative Health Screening Information
Preferred check-up program
Preferred Date
Medication Intake (0/300 C​haracter )
History of disease (0/300 C​haracter )
Hotel Address
Comments (0/300 C​haracter )

Asan Medical Center needs your consent to the collection, use and provision of your private information to a third party as follows in accordance with Article 15, Section 1, No.1, Article 23, Section 1, No.1 and Article 24, Section 1, No.1 of the 「Personal Information Protection Law」.

Personal Information CollectionㆍUse Consent

1. Purpose

Collection of Information for the operation of “Asan Medical Center Health Screening and Promotion Center health check-up appointment”

2. Collected Information

Personal Information: Name, Gender, Date of birth, Nationality, Phone number, Email address, Hotel Address, Preferred check-up program & Date, Comments.

3. Retention and period of use

The collected personal information is retained and used only during the service provision period for [Purpose of Collection and Use of Personal Information], and the information collected for the provision of medical services is kept in accordance with the Medical Act.
However, even if the purpose of collection and provision has been achieved, personal information may be retained if there is a need to keep it according to other laws and regulations.

4. Right to refuse the consent and disadvantages in case of refusal

You can refuse consent to the provision of the stated items, but please inform you that the health check-up reservation service is not available, if you do so.

I consent to the collection and use of my personal information as the above.      

Sensitive Information Collection·Use Consent

1. Purpose

Collection of Information for the operation of “Asan Medical Center Health Screening and Promotion Center health check-up appointment”

2. Collected Information

Sensitive Information : History of disease & drug

3. Retention and period of use

The collected personal information is retained and used only during the service provision period for [Purpose of Collection and Use of Personal Information], and the information collected for the provision of medical services is kept in accordance with the Medical Act.
However, even if the purpose of collection and provision has been achieved, personal information may be retained if there is a need to keep it according to other laws and regulations.

4. Right to refuse the consent and disadvantages in case of refusal

You can refuse consent to the provision of the stated items, but please inform you that the health check-up reservation service is not available, if you do so.

I consent to the collection and use of my Sensitive Information as the above.      

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If you have private insurance, you can charge the fee to your insurance company personally.