Refer a patient

Refer a patient by phone:

If your preferred choice is to refer through a phone call, please dial +234 (0) 807 420 2395 for patients' referrals and medical transfers.

Refer a patient online:

Please fill the information requested below into the secured form and the information provided will enable us to assist your patient as efficiently as possible.

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Referring Physician Information:

First Name: *

Last Name: *

Practice Name:

Email: *

Phone number:*

Patient’s Information

First Name: *

Last Name: *

Date of Birth (DOB): *

Age:

Sex: *

Address:

Phone Number: *

Medical Information

Diagnosis: *

Referring Physician: *

Reasons for Referral: *