Referral Form

Referral Form

The Referral Form is designed to capture basic, high-level information about your patient. This form is a preliminary requirement to initiate the referrals process and will help in directing our team to better manage the request accordingly.

Please fill out the form and either email or fax it using the information below. Once the form has been successfully received, our team will reach out to you and to the patient with additional enrollment information to help facilitate the process.

Referral Office Team


Referral Office opening hours are Sunday to Thursday, 8:00 AM – 6:00 PM.
To refer a patient, please contact the Referral Office team on:
Tel: +971 2 614 9912
Fax: +971 2 5633872

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