Patient Referral Portal

Partnering with healthcare professionals to provide seamless, specialized care for your patients.

Trust Us With Your Patient's Care

We value the trust you place in Health Connect Clinic. Whether for specialized dental procedures, aesthetic treatments, or general medicine, we act as an extension of your practice—ensuring your patients receive the highest standard of care before returning them to you.

1. Submit Details

Complete the secure form below with patient details and reason for referral.

2. Care Coordination

Our specialists review the case and contact the patient to schedule priority treatment.

3. Feedback Loop

We treat the patient and keep you informed (if required) regarding the outcome.

Secure Patient Referral Form

REFERRING DOCTOR DETAILS

NAME

SPECIALTY

MOBILE

For Pediatric cases, kindly provide parent / guardian details

PATIENT / PARENT NAME

PATIENT / PARENT MOBILE

REQUESTED SPECIALTY (DROP DOWN)

SPECIALTY

PATIENT DETAILS

PATIENT NAME

PATIENT DOB

PATIENT GENDER

EMIRATES ID / PASSPORT NUMBER

REFERAL FOR

CONSULTATION PROCEDURE TREATMENT

CASE INFORMATION

CC / HPI & DIAGNOSIS

BRIEF HISTORY

PLEASE ATTACH PATIENT’S MEDICAL REPORT / PHOTOS / RADIOGRAPHS

HIPAA/DHA Compliant: Patient data is encrypted and handled with strict confidentiality.

Partner Support Desk

Priority Line 04 554 7335

Doctor Liaison (WhatsApp) +971 52 368 4529

Clinic Location G05, Villanova Community Mall - Dubai

Working Hours 10:00 AM - 10:00 PM (Daily)