Danthaja Premium Dental Chambers
Dr. MANJULA HERATH
Oral And Maxillofacial Surgeon
Special Notes:
Please be present 5 minutes before the appointment time.
May 18, 2024
Sat 06:00 pm
Patient No.
01
Contact Hospital
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
*
Please note that the foreign numbers do not receive any SMS notification.
NIC
Passport
E-mail
*
Please enter email address if you require to send PDF receipt to your email account.
Address
Home
You haven't subscribed for "No Show Refund" service.
Do you want to subscribe and be eligible for full refund in case of cancellation?
×
Terms & Conditions
Do you really want to refresh?
