Request for an Appointment

To request an appointment with a Doctor at Al Rahba Hospital, please fill all details from the form below. By providing the complete information, enable us to serve you better and schedule your appointments more efficiently.
A representative from the "Appointment Section" will call you as soon as possible with the appointment date and time; however it may take up to two (2) working days to confirm.
If you would like to speak with someone directly, please call the "Appointment Section" from Sundays through Thursdays between 8:30 till 15:30 at (00971) 25064108 or (00971) 25064079.
Please note that we will not be able to provide any medical diagnoses or consultation through phone or e-mail. For Emergency cases, please dial (00971) 25064101 or immediately visit our Emergency Department.

Patient Information
* First Name:
 Second Name:
* Last Name:

Speciality
 Clinic:
 Doctor:

Insurance Details
* Insurance Card Type:
* Insurance Card No.:
* Date of Expiration:

Referral Details
 Have you received referral letters from Physician for this appointment ? 
 If yes, please specify details below or attach a copy
 Hospital Name:
 Referral No.:
 OR  Attach Referral letter:
 Appointment Reason: