Appointment Request Form
Welcome to the Online Appointment Form. We are pleased to assist you in scheduling your appointment. Please complete the form below with accurate information, and we will confirm your appointment through the contact details you provide. For further inquiries, feel free to reach out via email at drmwandochrispin@gmail.com. Kindly note that all virtual consultations will be conducted via WhatsApp (call/video) or phone call.
Full Name
*
Ms.
Mrs.
Mr.
Prefix
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Email Address
example@example.com
Preferred Consultation Channel
*
Please Select
WhatsApp call
WhatsApp video
Phone call
Appointment
*
Reason for consultation
*
Attach any results if available
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Package Details
1. Initial Online Consultation and Follow-Up: Includes one online consultation, with an option for a follow-up or review consultation within 21 days of the initial consultation if required. 2. Medication Prescription: A digital prescription (PDF) provided for any necessary medications following the consultation. 3. Laboratory and Radiology Orders: Laboratory and/or radiology requisition forms (PDF) will be provided if additional investigations are needed. 4. Specialist Referral: Referral to another specialty, as needed, based on the consultation findings.
Payment Procedure
Please be advised that the consultation fee is K100. Payments should be directed to the Airtel Mobile Money account associated with the number 0977914572, registered under Mwando Chrispin. Upon completing the payment, kindly send proof of the transaction along with your full name to the same number. Once payment is confirmed, your virtual consultation will proceed as scheduled. Thank you for your cooperation.
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