Submit Medical Needs

Fill in the information below, and one of our medical consultants will contact you within 1-2 business days.

Basic Information

Please enter your personal information

Name*

Gender*

Age*

Contact Phone*

Email*

Referrer

Please describe your eye condition and medical history in detail.

Main Symptom Description*

Past Medical History

Current Medication Status

Wear glasses or contact lenses?

Please enter your healthcare preferences (optional).

Expected City

Preferred Appointment Time

Preferred Hospital

Upload medical records, test reports, and other documents (optional; max 5 files, up to 10MB each)

Upload fileSupports PDF, JPG, and PNG formats

I have read and agreeTerms of Service、DisclaimerandPrivacy Policy, agree to use the above information for care coordination services

1Submit Request

2Document Review

3Initial communication

4Hospital Matching

5Schedule Appointment

6Appointment Completed