Expedited/VIP Surgery Consultation Form

Change Language English

Dr. Karim SERHAN

Consultant General and Laparoscopic Surgery

Diplomate of the American Board of Surgery

Adjunct Assistant Professor, United Arab Emirates University

Clinic #1

Al Ain, UAE

+971 600 55 0005

Clinic #2

Al Yahar, UAE

+971 3 765 0000

Consultation Request

Your information is strictly confidential and HIPAA compliant. All data is securely protected.

Type of Surgery Needed *

Full Name *

Phone Number *

Emirates ID (Optional)

Just enter the numbers, formatting will be automatic

Insurance Plan (Optional)

Brief Message About Your Condition (Optional)

Or Record a Voice Message

This helps the doctor understand your condition better before the consultation

Medical Report (Ultrasound/CT Scan)

Upload Files

PDF, JPG, PNG (Max 10MB)

Preferred Surgery Timing *

I consent to the collection and processing of my personal health information for consultation purposes in accordance with UAE data protection laws. I have read and agree to the Privacy Policy and Terms & Conditions . *

Expedited/VIP Surgery Consultation Form

Dr. Karim SERHAN

Clinic #1

Clinic #2

Consultation Request

Add more