Asiri Central Hospital - Norris Canal Road-Colombo 10
Dr. MANJULA HERATH
Oral And Maxillofacial Surgeon
Special Notes:
NO REFUNDS / CANCELLATIONS UNLESS APPROVED BY DOCTOR
May 5, 2024
Sun 09:00 am
Patient No.
01
9:00 AM
Closed
COMPLETE WITHIN
Nationality
Local
Foreign
Country
Sri Lanka
Maldives
Other
India
Dubai
Malaysia
China
England
Australia
Brazil
France
Japan
Pakistan
Bangladesh
USA
Canada
Indonesia
Italy
New Zealand
Qatar
Russia
Singapore
Thailand
Seychelles
Kuwait
Madagascar
Lebanon
Nepal
Mauritius
Myanmar
Oman
UAE
Patient's Name
Mr.
Mrs.
Mast.
Miss.
Dr.
Dr (Ms.)
Dr (Mrs.)
Prof.
Prof (Ms.)
Prof (Mrs.)
Rev.
Baby
Sis.
Ms.
Hon.
Rev. Sr.
Ven.
Rev. Fr.
Phone
+94
Other
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NIC
Passport
E-mail
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Address
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