Patients and Visitors Service

Dear Patient:

As part of our commitment to delivering the right health care for our patients at the right time, we are pleased to receive your service request, complaint, suggestion, and comments by filling out the below form.

Please fill the form below, and attach document if needed.

(With our best wishes for good health)

Patient Information Patient Medical record number This field is required! First Name This field is required! Family Name This field is required! Mobile Number This field is required!
Email
This field is required! Location Region This field is required! Hospital/ PHC This field is required!
Requested Service This field is required! Request Details This field is required! Add Attachments to this Record?

YOIY

Comments

Full Name This field is required!
Email This field is required! Invalid Email Format.
This field is required! Maximum 300 characters allowed.

YOIY

This field is required!

Patients and Visitors Service

Comments

Overview

Contact & Support

Important links

Patients and Visitors Service

Comments

Overview

Contact & Support

Important links

Social Media

Accessibility tools

Sorry.. Your browser is not supported