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REQUEST AN APPOINTMENT

Request An Appointment

Thank you for using the online request form for an appointment at Clemenceau Medical Center outpatient 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.
 
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.

FILL THE FORM BELOW TO REQUEST AN APPOINTMENT

Fields marked with * are required

Specialty *

Physician *

First Name *

Last Name *

Birthday *

Gender *

Address *

Preferred Date

Preferred Time

Telephone *

Mobile *

Email *

Country *

Insurance *