New Internal Treatment Request inside KSA

Main Details

*Please be noted that one single file should not exceed 5120 KB or 5 MB in size.
*Please Enter files type "PDF, PNG, JPG or JPEG" Only.

Do you need to create request for a dependent?

Dependent National Id

Request Category

Creator Party

Medical Report Document

Mobile Number

Is There is Acceptance in another Hospital?

Address Photo

Receiver Hospital

Acceptance Date

Acceptance Document

Request Type

Patient's Residence Region

Ministry Branch Request Sent To

Patient Location

*I agree that all information and attachments entered in this request is correct. I pledge to the validation of this information and I take the lawful and regulatory responsibility if proven otherwise

You must agree before submitting.