Contact Us Staff WebmaiWelcome to Promise Hospital |

Appointment

  • Book Appointment Form

    Complete the form below to request an appointment at Promise Hospital. An appointment representative will contact you within two business days to review your medical  information before an appointment may be offered.

    If you are having a medical emergency call or text  2348033033281.

    All fields are required unless marked option

    At which Promise Hospital location are you requesting an appointment?

    Promise Hospital Dopemu Agege Lagos Nigeria

    Promise Hospital Sango Otta Ogun State Nigeria

     

    Patient Information
    First Name
    Middle Name (optional)
    Last Name
    Formal Name (optional)
       
       
    Birth Date
     
    Gender Male Female
    Have you previously received care at Promise Hospital?

    Yes No Don't Know
    If Yes?  
    Treatment Type
    Your Medical Xpert No
    Your Card No
    Your Address
    City
    State
    Zip
    Your Mobile Phone

     
    Your Email

     

    Requester Information
    Who are you requesting this appointment for? Self Other

    Patient Billing(NHIS,HMO,CORPORATE ORG.) Information
    Do you belong to NHIS,HMO or Corporate Org? Yes No Don't Know
    If Yes?  
    HMO, NHIS, OR Corporate Org Name?

     

    Medical Concern
    What is the primary medical problem or diagnosis for your appointment request?
     
     

     

     
Follow @promisehospital