Booking Request

Dentistry

In-office Teeth Whitening (1 Session / 1 Cycle)

Impline Dental Clinic - Gangnam Samsung

Listed Price$103 (≈ ₩150,000)

SAFEDOC Price

33% ↓$69(≈ ₩100,000)

Today's Exchange Rate: ₩1,450 / USD

Patient Details

Full Name (Passport)

Phone No.

Date of Birth

Gender

Citizenship

Passport No. (Optional)

Required Interpretation Language

Medical & Surgical History

Current Medications

Allergies

Additional Notes (Optional)

What's Included?

Consultation

Hospital Booking Details

Preferred Date (1st choice)

Preferred Time (1st choice)

Preferred Date (2nd choice)

Preferred Time (2nd choice)

Dates of Stay in Korea

Arrival Date in Korea

Departure Date from Korea

Add-ons (Optional)

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