Location: Lady Pohamba Private Hospital, Demushuwa Suites, Suite 8A | Call Us: 061-240 110 or 083 707 1239
Ob-Gyn Practice
Complete the form below, and our team will confirm your appointment.
First Name *
Last Name *
Date of Birth *
ID / Passport Number
Mobile Number *
WhatsApp
Email Address *
Preferred Date *
Alternate Date
Is this your first visit to OB-GYN Practice?
Yes, new patientNo, returning patient
Medical Aid Name
Medical Aid Number
Brief Reason for Visit / Additional Notes
Full Name
Relationship — Select —Spouse / PartnerParentSiblingChildFriendOther
Emergency Contact Number
yes
I confirm that the information I have provided is accurate. I consent to OB-GYN Practice processing my personal and medical data strictly for the purposes of scheduling and delivering healthcare services, in accordance with their Privacy Policy and applicable Namibian data protection legislation. *
I agree to receive appointment reminders and health communications from OB-GYN Practice via SMS, WhatsApp or email. (Optional)
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