Saturday 7:00 PM - 9:00 PM Sunday & Tuesday: 7:00 PM - 9:00 PM For more information contact us at: Welcome to our clinic, we are committed to providing you with the best medical care possible; we encourage you to ask all your questions. Please assist us by providing the following information, all information is confidential. Personal Data: Patient Full Name: Date of Birth: / / Nationality: Occupation Marital status: S / M / D / W Name of Spouse: Occupation: Age: ID card Number or Passport Number: Issued at: Exp. Date : / / Home Address: City: Country: Telephone: Home: Work: Number of Deliveries: Cycle: Reg. / Irreg. LMP: / / Pain: Bleeding: Menopause: Years: Medical Disorders: Diabetes: Hypertension: other: Wt. Kg. Contraception: HRT: Alcohol: /d Smoke: /d This information sheet belongs to Have you ever suffered from: Yes / No Complaint: In patient own words Recurrent urinary tract infection: Recurrent vaginal infection: Chronic constipation: Chronic cough: Lung & Heart disease Kidney disease Liver disease Sexually transmitted disease: Other:
Seif-Eldin Hospital. Hosny Hospital.
4,
Heliopolis, Cairo, Egypt Mohnadessine, Giza, Cairo - Egypt
Tel: (+202) 24174355 - 24174366 Tel: (+202) 33377205
Working Hours: Working Hours:
Monday & Wednesday: 10:00 AM – 12:00 PM
Please call to schedule a visit: (+2) 012-3675300 or (+2) 010-5250230
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Egypt Urogynecology Clinic:
Tel: (+2) 0123675300 or (+202) 24174355
email: amr@urogyn-eg.com
Dr. Amr Seif-Eldin
Tel: (+2) 010-5250230 (private)
email: a.seifeldin@gmail.com (Private)
For Internatinal medical packages please call or email us at:
Medical secretary:
Tel: (+2) 0123675300
email: amr@urogyn-eg.com
Or UK. Liaison: Ms. Joanna Clark, RN
Tel: (+44) 07796621161
email: jclark93@btinternet.com
We can assist you with hotel reservation and airport pick up, just email our medical secretary
A variety of sightseeing tours are also available, we can help you get in touch with our tour operator
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Please fill this form and email it to us
Patient Information Sheet: Ref. #: _____________ Date: _______________
* optional
e-mail:
Previous Surgery: Abdominal: Vaginal: Other:
Allergies: Glucoma: Drugs: Aspirin:
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