021 _ 669 669 00 info@raymon24.com اللغة العربية

ویزای درمانی ایران

Dear Guest 

For applying your treatment visa please fill the form and email it for us

 VISA application form


Passenger 1 (بیمار)



First Name(s)




Family Name




Your father’s first name




Gender  (male/female)




Marital Status (married/not married)




Date of Birth




Current Nationality




Passport No.




Date Of Passport Issue




Date Of Passport Expiry




Address: ******************************

Postal code, City, Country




Phone No. (and/or cell no.)




Email ***




Your occupation/profession

If (ex) governmental, please mention




Travel Entrance To Iran (city)




Travel Plan in Iran

(cities & planned transport)


Booked/planned hotel

(Name hotel & city)


Where do you want to collect your visa? (country/place/Iran airport)




Have you been to Iran before?

 (which dates)








Arrival and Departure Information

(If you don’t have your tickets yet or travel overland, just fill out the date of your expected arrival and departure)

Flight to Tehran?



Flight No.


Arrival date/time Iran


Return Flight



Flight No.


Departure date/time Iran


Health Information

Do any of the above Passengers suffer from any pre-existing illness or disability that may affect travel or require special attention? No   (If yes, please state the nature of condition and fitness to travel) 

Emergency Contacts

Please advise a name, address and telephone number (needed in case of emergency only):


Visa process agreement

  2  I confirm the correctness of all the information given.  Iagree


Important Notes:

1. We will do our best to secure your visa; however the final decision rests with the Visa authorities in Tehran. Therefore we cannot 100% guarantee if and when your visa will be granted.

2. Your passport should be valid for at least 6 months after your return from Iran

1.     3. E-mail us a scan or digital photo of your passport (personal details page) in jpg format max 250kb.

4. Your passport cannot contain any stamps of Israelian customs

5. A medical insurance is required to travel in Iran