Appointment Form | LifeLink Hospital

Request an appointment

Appointments at Lifelink Hospital Please complete the form below to request an appointment at Lifelink Hospital or Medical Center.An appointment representative will contact you within 24hrs to review your request, before an appointment may be offered. If you are having a medical emergency, call 911 or emergency medical help. All fields are required unless marked optional.

Schedule Information

Please complete the form below to request an appointment and we will contact you shortly to confirm. Thank you, and we look forward to seeing you!

Office Location *

Lifelink Hospital - Namugongo

Lifelink Medical Centre -Ntinda

Medical Information

Any Specialization

Want to see a particular Doctor

Nature of Appointment

Schedule Date

Date *

Month

Day

Year

Time *

Hour

Minute

Personal Information

First Name *

Last Name *

Your Age *

Email *

Main Phone *

Alternate Phone

Address

Home Address *

Work Address

District / Town *

Visited Lifelink before? *

Yes

Do you have health insurance? *

Yes

Patient Insurance Information

Insurance Service Provider

Insurance Service Provider *

Insurance Medical number