To refer your patient for an appointment with one of our doctors, please complete an online request using the form below. Once we receive your request, we will contact your patient directly within 24 hours to schedule their appointment.
For referrals to Al Jalila Children's, kindly fill in the respective form and email it to us. Our Case Management team will get in touch with you soon. Kindly note to attach copies of patient's Emirates ID and insurance to enable us to verify and proceed with a referral.
Diagnostic Imaging Department Outpatient Order Form
NICU Referral Form
Mental Health and Psychology
Electro Neuro Diagnostic Study