Patient Registration System

Title *

First Name *

Father's name *

Surname *

Sex *

Marital Status *

Date of Birth (should be in dd-mm-yyyy format) *

Place of Birth *

Address *

Post Code / Area *

City *

Country *

Email *

Telephone *

Additional Number *

ID Type *

National ID

Iqama

ID Number *

All filename(s) should be in english only.*

Upload National ID

File(s) to upload:

Are you KSAU-HS employee? *

Yes

Do you have COD - Riyadh MRN? *

Yes

Do you have MNGHA - Riyadh MRN? *

Yes

Do you want to register your Dependent(s)? *

Yes

I agree to all terms and conditions.