Refer a Patient

Select Department

Select DepartmentCardiology DepartmentDental DepartmentDermatology DepartmentEndocrinology DepartmentENT DepartmentHaematology DepartmentInternal Medicine DepartmentLanguage and Speech DepartmentNephrology DepartmentNeurology DepartmentNutritionNutrition DepartmentObstetrics and GaenocologyOrthopaedics DepartmentPediatrics DepartmentPsychiatry DepartmentPsychology DepartmentSurgery DepartmentUrology Department

Appointment NotesUrgentFirst Available

Reason for referral/specific medical concern

Patient Information:

Patient Gender MaleFemale

Patient Date of Birth

Parent/guardian name* (if under 18 years of age

Due to COVID-19, our specialists will conduct virtual visits when appropriate

Does the patient need an interpreter?* YesNo

Medical Records:
Please upload referral medical records. If you are unable to upload files here, you can scan them to info@nhl.co.ug.
File types accepted: .pdf, .tif

File 1

File 2

File 3

Insurance Information:
Does the patient have insurance?

Yes, Patient has InsuranceNo, Patient does not have insurance

Referring Physician:

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Legal notice information:
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