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+ 1 541-754-3010

Online Forms

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+ 1 541-754-3010

Online Forms

Here are some important forms you to review and complete prior to your appointment with one of our physicians or provider.

  • Screening Checklist for Visitors
  • New Patient Enrollment Form
  • Medical History Form
  • Online Doctor Appointment Form
  • Psychiatric Evaluation Form
  • Quick Emergency Contact Form
  • Blood Donation Form
  • HIPAA Privacy Restriction Questionnaire
  • Medical Release Form

Explore our services to find the care that’s right for you or your organization. Contact us to schedule an appointment or inquire about our healthcare packages. Your path to better health starts with Quality Medicare.

+2349114095507

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Contacts >

Address:

Phone:

Opening Hours:

1 Ekololu St, Surulere 101241, Lagos, Nigeria

+2349114095507

Mo-Fr: 09:00-17:00h

Address:

1 Ekololu St, Surulere 101241, Lagos, Nigeria

Phone:

+2348052727410

Opening Hours:

Mo-Fr: 09:00-17:00h

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+ 234 9114095507

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1 Ekololu St, Surulere 101241, Lagos, Nigeria

Book Virtual Consultation