Appointment with doctor

Make an Appointment

[EN] Appointment /w Doctor

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Please complete the form below to request an appointment at BNH Hospital. After you submit the form,
a representative will contact you within 48 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 have any problem with online appointment please contact webmaster

Appointment Information

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Doctor Name *

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Appointment Information

Preferred Appointment Date *
please make an appointment at least 2 day

Time *

Special Request

Patient Information

Title *

Full Name *

Date of Birth *

Contact Email Address *

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