APPOINTMENT BOOKING

PKLI&RC OPENS DOORS FOR APPOINTMENTS!

TO SCHEDULE AN APPOINTMENT
Please fill in the form.

Form for Physical Appointment in PKLI

"*" indicates required fields

Name*

Full Name

Date of Birth*

Daytime Phone*

Address*

Address

Province*

District*

Tehsil*

Email

Has the Patient been seen at PKLI in the past?*

Yes

No

Patient Medical Record Number*

Reason for Appointment*

Department

1st Preference Date*

1st Preference Time*

HH

:

MM

2nd Preference Date*

2nd Preference Time*

HH

:

MM

Additional Details

Comments

This field is for validation purposes and should be left unchanged.