APPOINTMENT BOOKING FORM

64 Slice CT scanner

   PATIENT BIO-DATA           
A previously registered Patient? * If yes, enter your registration number  
Title      Sex *                          
Surname *    Occupation *                         

Digital Dental Chair

 Other names *    Date of Birth *         Calendar
Address * Mobile Phone *
Home Phone   E-mail *
Office Phone      

C-arm Fluoroscopy

        
   

APPOINTMENT

* Select from the unit or investigation for your appointment

4D Ultrasonography
  Unit Appointment requested

 Investigation Appointment Requested

 
 

* Selections for Appointment

 select the investigation and click add   

Type of Patient *   Date of Preferred Appointment *           Calendar
  Time of Preferred Appointment *                                                         

Digital Mammography with stereotatic biopsy
If the preferred time/date is not available, will a substitute time/date be acceptable ? *     
Date of Substitute Appointment Calendar Time of Substitute Appointment  

 
 

** all the red marked boxes must be filled

 
 

Your appointment will be confirmed to you within 72hrs via your EMAIL or PHONE.