Appointment

Patient Information for Clinic Visit

Patient Name *

Sex *

Male

Female

Age *

Merital Status *

Married

Unmarried

Condition *

New Patient

Old Patient

Preferd Appointment Via *

Consultation in Clinic
(60.00 KWD Session Fees)

Email Address *

Whatsapp Number *

Upload Previews Prescription or Report Documents
Please keep your file less than < 10MB (jpg,png,pdf)

Drop files here or click to upload.

Additional Message *

I agree with the terms and conditions

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