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Simply complete the form below to request for an appointment. We shall be in touch with you within the next business day to confirm.

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Request an Appointment

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Cleveland Clinic Abu Dhabi > English > Patients & Visitors > Forms & Requests > Request an Appointment

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Patients & Visitors
Forms & Requests
Request an Appointment

Thank you for requesting a callback

We will contact you shortly to confirm your appointment details.

Thank you for requesting a callback

We will contact you shortly to confirm your appointment details.

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

Who is this appointment request for?

Myself

Someone else

Is this the first time visiting?

Yes

No

What's your relationship to the patient?

Your Contact Information

Your First Name

Family/Last Name

Phone Number

Email Address

Is this the first time visiting?

Yes

No

Patient Information Your 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

Date

Month

Year

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

COUNTRY OF RESIDENCE

Patient Phone Number

Patient Email Address

Preferred callback time

Reason for Visit

How did you hear about us?

Please select an option from below:

TV ad
Radio ad
Newspaper /
magazine ad
Outdoor ad
(e.g. billboard)
Online ad
Search engine
(e.g. Google search)
Social media
Event
News article or media appearance
(TV, radio, news)
Family/friend/
colleague referral
Physician referral
Other

Please Type Other Source

New patients to Cleveland Clinic Abu Dhabi may provide additional details below to expedite registration.

Additional Patient Information

Gender

Male

Female

Patient Nationality

Patient Emirates ID #

The patient does not have an Emirates ID #

Patient Address

COUNTRY OF RESIDENCE

Apartment or Villa or Building Name/Number

Address line 1

Address line 2

City

PO Box

Patient Health Insurance

By providing patient health insurance details, we will verify your policy coverage and discuss with you if and how it applies at Cleveland Clinic Abu Dhabi.

How would you like to pay for treatment at Cleveland Clinic Abu Dhabi?

Health insurance

Self payment

A financial counsellor is available to discuss payment options.

Please complete the fields below and click here to upload your insurance documents.

UPLOAD DETAILS

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Please ensure you upload a copy of both the front and back of your health insurance card.

Health Insurance Payer

Group/Policy Information

All Daman Enhanced Plan members (excluding Network 6 and 8) residing in UAE are covered for inpatient and day care cases (IP Only).

Thank you for providing additional information

We will contact you shortly to confirm your appointment details.

Appointment scheduling by phone is available from 7:00AM to 7:00PM on weekdays. Alternatively, complete our online form and receive a callback to confirm your appointment.

The Emergency Department operates 24 hours a day, seven days a week, 365 days a year.

Please note that you may call us at any time for general information.
800 8 CCAD (800 8 2223)
From outside the UAE +971 2 659 0200

Now accepting select plans from the following health insurance companies:

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