Online Reception form

Firstname

Lastname

Father's Name

Date of birth

Passport ID

Place of Exportation

Education

Job

Marital status

Patient's name on the day of the operation

Residential address

Calling number 1

Calling number 2

Description

Picture of the patient's inpatient order

Picture of the patient's Passport

Services

working hours

Saturday

7-22

Sunday

7-22

Monday

7-22

Tuesday

7-22

Wednesday

7-22

Thursday

7-22

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