| SHMC ID No |
|
| Name |
|
| Password |
- Use 8-20 characters, including at least two of each of the following: uppercase/lowercase, number and special character (~!@#$%^&*).
- 10 or more digits for 2-type combination, 8 or more digits for 3-type combination.
|
| Confirm Password |
|
| Gender |
|
| Date of Birth |
|
| Residence Card No. |
|
| Passport No. |
|
| Nationality |
|
| Language |
|
| Residence |
|
| Travel Plan |
|
|
|
|
| Korean National Health lnsurance |
|
| Private Health Insurance |
|
| Contact Information |
Phone No |
-
-
-
|
| E-Mail |
@
|
| Address in Korea |
|
| Address in Overseas |
|
| Emergency Contact |
Name and Relationship |
|
| Phone No |
-
-
-
|
| Symptoms & Medical Services Required |
|
| Comments |
|
| Preferred Date & Time |
Choice 1st |
|
|
| Choice 2nd |
|
|
| Type the characters above |
Refresh
|
