JCI Certificate

Request an Appointment

This form is not to be used in an emergency. If this is an emergency, please dial: 17812111
(24 hours Emergency Services).

For immediate appointments call our Appointment lines: 17812200, 17812201,
17812222, 17812000.

Appointment Timing:
Saturday – Wednesday:  8:00 a.m. – 8:00 p.m.
Thursday:  8:00 a.m. – 6:00 p.m.
Friday: Holiday.

Patient Information:

Last Name :

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First Name :

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Gender :
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Date of Birth :

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Mobile No. :

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Phone No. :

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E-mail Address :

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Bahrain Resident:

House No. :

Road :

Block :

CPR No. :

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Non-Resident:

Address :

Country :

Passport No. :
   

Appointment Information:

Type of Appointment:

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BSH patient Medical Record (MR) No. :

Date :

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Time :
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Specialty :

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Doctor :

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Briefly describe symptoms/ reason for appointment :
(Optional)