ONLINE PAYMENT FORM

Credit/Debit Card Holder's Full Name*

Credit/Debit Card Holder's E-mail*

Credit/Debit Card Holder's Address*

Credit/Debit Card Holder's Number*

Credit/Debit Card Holder's Expiry Date

Credit/Debit Card CVV/Security Number*

Amount to be Charged*

Currency*

Your payment will be processed by mail order. Deposits are not refundable

The Coolest Clinic is an accredited medical travel and intermediary company with the code 13066, with the membership of TÜRSAB (Association of Turkish Travel Agencies) by the Ministry of Health.