E-Appointment for Special OPD Clinic

Please use the form below to request an appointment. This form will be sent to a registration desk at our facility. Our registration staff will call you back within one business day to confirm a date and time with you. Our registration staff receives Internet inquiries and will place phone calls between 10:00 a.m. to 5 p.m., Sunday through Friday. All submissions will receive an automatic e-mail informing you that we have received your information.
Note: This form is not for people who need urgent medical care. For medical emergencies go immediately to the nearest emergency room.

Patient Information:
Name:  
Gender:  Male  Female
Date of Birth: (mm/dd/yyyy)
Contact Information:
I am :   Patient   Relative   Friend
Name:
Address:  
Email:    
Primary Ph. No.:  
Secondary Ph. No.:  
Reason for visit:  
Please indicate the day and time you would like to schedule your appointment. This information will expedite the process when our registration staff calls you. Preferred Day and Approximate Time for Appointment (We will identify a specific time when we call you.):
Date: (mm/dd/yyyy)  
Time:  
Please indicate the doctor's name and department (indicate "Don't Know", if you don't have specific choice to indicate)
Doctor Name:  
View list of OPD doctors
Thank you for completing the form.
To proceed click on Submit to send the information or click on cancel if you do not want to send the information.
   

Thank you for choosing B&B Hospital.

 

Call B&B Hospital Special Clinic - 5554435
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10:00 am to 3:00pm (Sunday to Friday)