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Online
Consultation
Request.

Kindly fill the form below to
request an online telemedicine
consultation at MeQrez General
Hospital

    Appointment Details

    Specialty Doctor name
    (if you have a preference)

    Preferred appointment date

    State your medical concern or request

    Hospital number(if available)

    Patient Details

    Full name (as on passport)

    Gender

    MaleFemale

    Date of birth

    Email address

    Phone number (include country code)

    Nationality