MHC
CONSULTANTS
CLINICS
TECHNOLOGY
PHOTO GALLERY
Request for Appointment
If it is an emergency appointment, please dial
+880 2 9896623
+88 01714090000
+88 01911555555
880 2 9891661~2 Ext:7777
Please be informed that this submission of “Request for Appointment” will only be workable after confirmation by our “Appointment Call Center”. Confirmation of Appointment depends upon the availability of doctors at your preferred date and time.
Your appointment will be confirmed through return e-mail or telephonic communication.
You must fill the
*
marked fields to submit your request
Title: (Mr./Mrs./Ms./Dr./Prof.)
Full Name:
*
Date of Birth:
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*
Are you already registered with us?
Yes
No
*
Universal Health Identification (UHID):
(If Known)
Email: ( Your Appointment Schedule will be replied through this e-mail)
*
Telephone:
*
Brief Description of your Problem:
Specialty:
Choose Speciality
ADULT NEUROLOGY
CARDIO THORACIC
DENTAL SURGERY
DERMATOLOGIST
DIABETOLOGY & ENDOCRION
GASTRO ENTROLOGIST
GENERAL AND LAP SURGERY
INTERNAL MEDICINE
INTERVENTIONAL CARDIOLOGY
NEPHROLOGY
NEURO SURGERY
OBS-GYNAE
ONCOLOGY
OPHTHALMOLOGY
ORTHOPAEDICS & TRAUMA
OTOLARYNGOLOGY
PAEDIATRICS
PAEDIATRIC SURGERY & PAEDIATRIC UROLOGY
PHYSICAL MEDICINE
PLASTIC &COSMETIC SURGERY
PSYCHIATRIST
RESPIRATORY MEDICINE
RHEUMATOLOGY & INTERNAL MED
UROLOGY
Not Known
Doctor:
Preferred Date and Time for Appointment:
1st Preference-
Date:
Month
Jan
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2008
2009
Time:
2nd Preference-
Date:
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2008
2009
Time:
Remarks:
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