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Dear patient,

To provide the best support for your case, we would like to know more information about you and your condition. This information will help us find the best help for you.

Any information submitted in this form is held and processed privately within the GMS team, and only shared with potential medical providers (doctors, hospitals) when absolutely necessary to analyze your condition and to seek treatment options for you. You can always request us to delete your records by sending email to info@gms-cyprus.com.

GMS Medical Case Registration Form

Last Page

Personal information

Full Name *

Date of Birth *

Gender *

Contact information

Email *

Phone Number *

Please include your country code

Country of Residence *

Preferred Language of Communication *

Medical details

What medical problem or diagnosis are you seeking help for? *

Please describe briefly

When did the problem start? *

Have you been diagnosed by a doctor? *

If yes, please specify the doctor’s name and specialty.

Have you already had any treatments or surgeries related to this condition? *

If yes, please describe.

Do you have any other medical conditions we should know about? *

Yes/No. If yes, please describe.

Are you currently taking any medications? *

Yes/No. If yes, please describe.

Supporting information

Please upload any relevant medical documents (MRI / CT / X-ray / reports / doctor’s letters). *

Drag and drop media files to upload or

Maximum file size: 10 MB

0/10

Allowed files: images, PDFs, documents, up to 10MB each. You can upload up to 10 files.

Do you have a medical insurance that may cover your treatment abroad? *

Yes/No. Please describe your insurance policy (if any).

If yes, please upload a copy of your insurance policy.

Drag and drop media files to upload or

Maximum file size: 10 MB

0/5

Allowed files: images, PDFs, documents, up to 10MB each. You can upload up to 5 files.

Final details

Are you available to travel to Cyprus for treatment in the next 1–2 months? *

Will you need assistance with travel and accommodation arrangements? *

Who referred you to us?

Additional Comments

Consent to Service *

I confirm that the information provided above is accurate and that I consent to GMS Cyprus reviewing my case and contacting me for medical evaluation.

Privacy *

I read and agree to GMS Privacy Policy

If you have any questions, please contact us via info@gms-cyprus.com, or send us direct message on WhatsApp or Telegram.