Patient Details Name * Mobile No * Zone * Select Patient's Zone 1 - Al Jasrah 2 - Al Bidda 3 - Fereej Mohamed Bin Jasim 4 - Mushayrib 5 - Al Najada 5 - Barahat Al Jufairi 5 - Fereej Al Asmakh 6 - Old Al Ghanim 7 - Al Souq 10 - Wadi Al Sail 11 - Rumeilah 12 - Al Bidda 13 - Mushayrib 14 - Fereej Abdel Aziz 15 - Ad Dawhah al Jadidah 16 - Old Al Ghanim 17 - Al Rufaa 17 - Old Al Hitmi 18 - As Salatah 18 - Al Mirqab 19 - Doha Port 20 - Wadi Al Sail 21 - Rumeilah 22 - Fereej Bin Mahmoud 23 - Fereej Bin Mahmoud 24 - Rawdat Al Khail 25 - Fereej Bin Durham 25 - Al Mansoura 26 - Najma 27 - Umm Ghuwailina 28 - Al Khulaifat 28 - Ras Abu Aboud 30 - Duhail 31 - Umm Lekhba 32 - Madinat Khalifa North 32 - Dahl Al Hamam 33 - Al Markhiya 34 - Madinat Khalifa South 35 - Fereej Kulaib 36 - Al Messila 37 - Fereej Bin Omran 37 - New Al Hitmi 37 - Hamad Medical City 38 - Al Sadd 39 - Al Sadd 39 - New Al Mirqab 39 - Fereej Al Nasr 40 - New Salatah 41 - Nuaija 42 - Al Hilal 43 - Nuaija 44 - Nuaija 45 - Old Airport 46 - Al Thumama 47 - Al Thumama 48 - Doha International Airport 49 - Doha International Airport 50 - Zone 50 57 - Industrial Area 58 - Zone 58 61 - Al Dafna 61 - Al Qassar 63 - Onaiza 64 - Lejbailat 65 - Onaiza 66 - Onaiza 66 - Leqtaifiya 66 - Al Qassar 67 - Hazm Al Markhiya 68 - Jelaiah 68 - Al Tarfa 68 - Jeryan Nejaima 53 - Muaither 54 - Fereej Al Amir 54 - Luaib 54 - Muraikh 54 - Baaya 54 - Mehairja 54 - Fereej Al Soudan 55 - Fereej Al Soudan 55 - Al Waab 55 - Al Aziziya 55 - New Fereej Al Ghanim 55 - Fereej Al Murra 55 - Fereej Al Manaseer 55 - Bu Sidra 55 - Muaither 55 - Al Sailiya 55 - Al Mearad 56 - Fereej Al Asiri 56 - New Fereej Al Khulaifat 56 - Al Mamoura 56 - Abu Hamour 56 - Mesaimeer 56 - Ain Khaled 81 - Mebaireek 90 - Al Wakrah 91 - Al Thumama 91 - Al Wukair Is patient insured? Insurance Details Company * Select Insurance Company Insurance Card * Claim File * Qatar ID * Prescription Details Upload Prescription(s) * Comments (optional) Instructions for uploads Only JPEG/JPG, PDF file types are allowed. Ensure that the picture or scan is such that the entire prescription is visible (including the doctor/clinic's letterhead). Ensure that the picture is taken in a way that the handwriting/type is visible clearly. The total size of all uploaded files should not exceed 5 MB. Ensure that the prescription is valid. You family member or a caregiver can place order for prescription medicines on your behalf. Please be sure to also upload the back-side image of your prescription, if present. I hereby agree and accept Privacy Policy Upload
