TAMA Free Clinic Tele Consultation Patient Registration
TAMA Free Clinic Tele Consultation Patient Registration.
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TAMA Free Clinic 2020 Details
Patient Last Name *
Patient First Name *
Patient Representative Name *
Contact Number *
Email *
New Patient *
Requested Date *
Do you have kind of health insurance? (Travel,Visitor,International) *
If you have selected NO for above section. Please download the GADPH patient form from below link and complete it and email to clinic@tama.org. https://tama.org/documents/GADPH-PatientForm.pdf
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