LMC Appointment Request
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National ID
*
First Name
*
Last Name
*
Date of Birth
*
Sex
*
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Email Address
*
Mobile No
*
Password
*
Department Name
*
Select Department
Emergency Room
PM
SPECIAL NEEDS CLINIC
Pschiatric Health Clinic
THE PHARMACY
Geriatric clinic
WOMAN HEALTH CLINIC
PHYSIOTHERAPY CARE
PRE-EMPLOYMENT MEDICAL CHECK UP
DENTAL CLINIC
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CDC clinic
Doctor Name
*
Appointment Date
*
Serial No
*
01
02
03
...
N
Problem
Purpose
*
INFORMATION ONLY
GERIATRIC CLINIC
PRE-EMPLOYEMENT MEDICAL CHECK UP
PRE-MARRAGE MEDICAL CHECK UP
ANC
CDC
WB & VACC.
WALK-IN CLINIC
EMERGENCY ROOM
TO SEE ADMIN
FOR REGISTRATION
OTHERS
Appointment for
*
In Hospital
Visiting at Home
Video Call
Address
*
Person to Contact
*
Doctors Fees
*
Payment Type
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LMC Appointment Request
LMC Appointment Request