Burjeel Hospital

request an appointment

To set up an appointment with one of our specialists, please provide us the following information

Please note that this is only a form to Request for an appointment. Filling this form does not confirm your appointment booking. Our call centre team will call you to confirm the appointment slot and doctor based on availability.

* Marked fields are mandatory.

Patient Information

First Name*
Middle Name
Last Name*
Nationality *
Gender*
 Male   Female 
 

Contact Details

Telephone
Mobile *
Email *
City *
Country *
 

Preferred Dates

Date Time 1
$('#date_time_1').datetimepicker({
	    
    hourMin: 9,
	hourMax: 20,
    
    minDate: new Date(2015, 4, 29, 5, 05),
	ampm: true
    
    
});
Date Time 2
$('#date_time_2').datetimepicker({    
    
    
    hourMin: 9,
	hourMax: 20,
    
    minDate: new Date(2015, 4, 29, 5, 05),
    
    
    
	ampm: true
});

Appointment Details

Department
Case Summary

   
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MOH Approval No. QN13441