Patient Inquiry Form --

To inquire with MedSolution.com, please fill out and submit our contact form. A patient care coordinator will contact you, explain our process and address any questions you may have.

First Name:	*
Last Name:	*
Address:
City:
State/Province:
Country:	*
Zip/Postal Code:

Phone Number:	*
Email:	*

When is the most convenient time to contact you?:	*
Preferred method of contact:	*

What type of treatment are you seeking information on?:	* IMPORTANT: Please specify a procedure
Any other information that would help us assess your requirements?:

When would you like to have treatment?:

Country of Choice:	*
If you selected 'Other':

How did you hear about us?:	*
If you selected 'Other':

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MEDSOLUTION
#2001-7495 132nd Street
Surrey, British Columbia, CANADA V3W 1J8

Toll Free Phone: 1.800.984.0457
International Number: +1.604.635.3431
Toll Free Fax: 1.800.984.0458

Email: info@medsolution.com

Live Help:

For International Callers:

Africa, Europe, China, Japan, N.Korea, UK, U.A.E.
00 + 1 + 604 + 635 3431

Japan, Thailand, S. Korea
001 + 1 + 604 + 635 3431

Australia
0011 + 1 + 604 + 635 3431

Russia
8~10 + 1 + 604 + 635 3431

If you do not see your country listed above, try this website.