SPRING GARDEN: APPOINTMENT REQUEST
This is an Appointment Request Form. We will get back to you by phone within 30 mins of getting this request and confirm your appointment request. You will get this confirmation call on the the next working day if you make the request outside our working hours. Thank you.
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Where would you like to get an appointment? *
*If it is your first visit to the Medical Clinic, we strongly recommend that you take your first appointment with any of our Family Physicians.
Is there a preferred Specialty, Doctor or Therapist you would like to consult? *
If YES, who is the Doctor or Therapist, or which is the Specialty you would like to consult?
What is your preferred date of appointment? *
Appointment depends on the availability of the Doctor
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What is your preferred time of appointment? *
Appointment depends on the availability of the doctor.
Time
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Any further information you would like to provide?
NAME OF PATIENT *
AGE OF PATIENT *
WHATSAPP NUMBER *
EMAIL ADDRESS *
I consent to being contacted on my Whatsapp/ Mobile number or by email regarding my appointment at Spring Garden. *
Required
Name of person filling in this form *
Thank you!
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