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Please provide your information with us
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Mr.
Ms.
Mrs. |
| First Name
: * |
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| Last Name
: * |
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| Birth date: |
DD- MM -YYYY |
| E-mail 1
: * |
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| E-mail 2
: (optional) |
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| Country : |
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| Phone
: |
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Have you ever visited
Thantakit before? |
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Yes
No |
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Your Preferred
Appointment Date & Time |
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Date |
Closed
4-5 Dec, 31 Dec, 1-2 Jan |
Time
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Which hotel
would you stay in Bangkok? |
| Hotel
Name |
Partner Hotels |
| Location
(road/street/area) |
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Do
you need our free hotel pick-up service?
(Not Available on Sundays) |
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Yes
No |
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Which
branch would you like to visit us? |
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Thantakit
Building Head Office (New Petchburi Road)
Closed on Sundays
All Seasons Place branch (Wireless Road)
Closed on Sundays
Pratunam branch (Petchburi Road) |
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Which treatments are you
interested in? |
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Should
you have your X-rays, pictures, or dental records, please send
directly to
dentists@thantakit.com |
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More
details: |
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