Refer A Patient

Please complete the simple form below, including as many as details as possible, in order to help us identify a specialized physician to meet your patient's specific needs.

Referring Physician Information

Physician First Name

Physician Family/Last Name

Physician Email Address

Physician Phone Number

Healthcare Facility Name

Physician Specialty

Physician License Number

Referred To Clinic

When Does The Patient Needs To Come In?

Patient Information

Please ensure that the following information is provided exactly as it appears on the patient's Emirates ID or passport.

Patient First Name

Patient Family/Last Name

Date Of Birth

Gender

Please note, we are unable to accept patients under the age of 14, with the exception of our Eye Institute and Emergency Medicine Institute.

Patient Email Address

Patient Phone Number

Emirates Id

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Request an Appointment Patient Portal mobile app Patient Portal online Call us directly 800 8 2223 International patients

To schedule your appointment, please call our Contact Center between 7:00am and 7:00pm, Monday to Friday. Alternatively you can complete our online form & request a callback to confirm your appointment.

Disclaimer: Patients under the age of 14 are only accepted in our Emergency Department and Eye Institute.

Our award-winning Emergency Department operates 24 hours a day, 7 days a week.

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Refer A Patient

Referring Physician Information

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