Book Your Appointment

Please complete the form below and click "Submit".Fields marked with asterisks(*) are mandatory.

Department *

Service *

First Name *

Last Name *

QID/Passport Number*

Mobile Number *

Relation with the patient *

Others *

Number of visitors *

Patient First Name *

Patient Last Name *

Patient QID*

Country of Treatment *

Other Country *

MOPH Employee Name

Meeting Date *

Slot 1 *

Slot 2

Slot 3

Remarks / Reason for Visit(Max 2000 characters) *

Please mention in the remarks box if you require more than the pre-defined time slot limit.

Attachment

Allowed file extensions: jpg, jpeg, gif, png, doc, docx, pdf
Maximum file size: 2 MB.

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