We want only to ensure that we give you our best quality of service and that we understand your condition before proceeding with services, that no meaning is lost in translation.

Please note that we specialize in certain types of disease diagnosis and prevention. Please click the appropriate link at the bottom of the page for the BSI automated Request for Treatment page. Please allow up to 1 minute for the page to load, click only once.

You will be asked questions relevant to your needs, that we request you complete in clear and detailed terms, should take about 20 minutes, depending on which form you choose.

The BSI Request for Treatment Questionnaire can be stored and completed over time – there is no need to rush. You will also be able to print your answers for your personal files.

Please also note that we are only accepting patients who are based long-term in Bali. We are not able to offer lodging or outside care, we are a day clinic only.

The Questionnaire program resides on the BSI International Secure Server. This means your completed questionnaire is forwarded via a secure server to our staff, cannot be intercepted by outside agencies during transit. We fully respect and honor your privacy, your information will not be given to anyone without your consent.

Your completed form will be read by a nurse and doctor at BSI, not a computer. Your considered answers let us know you are serious about receiving therapies at BSI International Clinics, and also that both you and BSI have a basic understanding of your needs.

Thanks for your valuable time and caring patience.