RHSH

ROYAL HEART SPECIALIST HOSPITAL

One Way Market Road Gwagwalada Abuja FCT

Patient Appointment Booking Form

Fill in all required information accurately

1. Personal Information

First Name *

Last Name *

Age *

Gender *

2. Contact Information

Phone Number *

Email Address *

Full Address *

Occupation *

3. Medical Information

Duration of Complaint *

Medications Taken So Far

4. Appointment & Payment Details

Proposed Date of Hospital Visit *

Preferred Time *

Important Payment Information

A consultation fee of ₦5,000 is required for your appointment. You can make payment using the account details below:

Bank Account Details

Bank Name: UBA Bank

Account Number: 1029758556

Account Name: RoyalHeart Specialist Hospital limited

Note: You have two options:

Make payment online now and upload the receipt
Wait and make payment when you visit the hospital in person

Payment Method:

Pay Now Online

Make payment immediately and upload receipt

Pay at Hospital

Make payment when you visit the hospital

I confirm that all the information provided is accurate to the best of my knowledge. I understand that ₦5,000 consultation fee is required for the appointment and agree to the hospital's terms and conditions.

Need Help?

Call us at +234 803 673 6347 or email support@royalheart.com.ng

We'll contact you within 24 hours to confirm your appointment