Request for Medical Dispute Arbitration by E-mail

Notice

• Essential document for application

  Medical Dispute Arbitration Application Form

  Medical Dispute Arbitration Agreement Form

  Annexed Paper to Application Documents for Arbitration

  Agreement to Collect and Use Sensitive and Personal Information

  Copy of identification card All documents must be written by the applicant and signed If the applicant is not the patient, the applicant has to submit the power of attorney and certification document to prove the relationship with the patient

• Applicants who want to request mediation or arbitration by K-medi shall submit essential application documents such as the Mediation Application Form and Annexed Paper to Application Documents for Mediation written in Korean language. If the application documents are written in English, the applicants shall submit additional copies of Korean translations.
• Savings account : applicants shall submit savings account details for a Korean bank. If applicants submit savings account details for a foreign bank, We can’t make up the loss or profit cause by international remittance.
• When you receive refund, we can't make up the loss or profit caused by foreign exchange rates.
  • Download / Print the essential documents from the application form page
  • Write out essential documents and sign it
  • Convert the documents written by you to PDF files, and send them by E-mail to us
    (use the E-mail address below this page)
    If you cannot send your documents by e-mail, please send your documents to the fax number below.
  • f forcc@k-medi.or.kr
    Fax : +82-2-6210-0099
  • When the person who is in charge of receipt receives the application documents sent by you, after review, he will send a massage and savings account details for receipt of the application fee. If the person in charge finds some problems with your documents, he will also get in touch with you.
    regulation about application fee
  • If we confirm payment by you, Your application will be succeed and we will notify you of your case number in a few days.

Professional Counselor +82-2-6210-0080