Skip Repetitive Navigational Links

Appointments

Skip Navigation LinksHome > Patients Section > Request an appointment

Request an Out-Patient Clinic Appointment

Thank you for using the online request form for an appointment at Clemenceau Medical Center out patient clinics. This is a secure area. The information you enter and submit is confidential. Your request cannot be processed unless all the below fields are completed.

Specialty
Physician *

First Name *

Last Name *

Birth Date *

Gender *

Local Address *

Telephone *

Mobile *

EMail *

Country *

Insurance *

Our Patient Service Coordinator will call you between 8h30 a.m. and 5h30 p.m. (excluding weekends and holidays), to collect additional information and process your request.

© 2006 Clemenceau Medical Center | All Rights Reserved | Designed by WonderEight | Developed by Entelligence