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Short Appointment Form

Full Name

Preferred Date

Phone Number (with country code. No extra zeros or symbols)

Doctor

Country

I have read and agree to the Appointment Cancellation Policy.

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Appointments cancelled within 24 hours of appointment time will not be subject to any charges.
Appointments that are cancelled within 12 hours or less may incur a fee of 50% of the scheduled treatment/procedure.
Missed appointments may be subject to 100% charge of the booked treatment/procedure.
Patients who have booked through packages may forfeit one of their sessions based on the conditions outlined above.
We seek your kind understanding on this to ensure smooth operation of the clinic for both our patients and team.

* Please note that this is not a confirmed appointment. The clinic will contact you to confirm the appointment.

Full Name

Phone Number

Preferred Date

E-mail

Doctor

Country

Appointment Cancellation Policy I have read and agree to the Appointment Cancellation Policy.

* Please note that this is not a confirmed appointment. The clinic will contact you to confirm the appointment.

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