Make an Appointment!

Please complete the form below to request an appointment at Alliance Hospital. After you submit the form, a representative will contact you within 72 hours to review your medical information before an appointment may be offered.

Please note: This form cannot be used for medical emergency or scheduling same-day appointment. If you plan to visit us within 24 hours or have a medical emergency, please call (+234) 809 714 2623 Front Desk, (+234) 803 094 4858 Client Service Office


Your Appointment Information


Personal Information
First Name*
Last Name*
Email*
Date of Birth* (As shown in your Passport/ID Card)
Gender*
Country of Residence*
Country of Birth*
Primary Phone Number*
Preferences*
Recommend a Doctor for me
I will choose my Doctor
Doctors Available*
Date and Time of Appointment*
Do you have a special request: Please elaborate here...
 
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