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Galen House
Bulawayo
Please fill in the form below to request the services of Galen House once we receive your enquiry, we will coordinate all necessary arrangements with the service provider on your behalf.
Section 1: Sponsor Information
Your full name
Your Email Address
For booking confirmation
Your Phone Number
*
Include international code
Section 2: Patient Information
Patient Full Name
Person receiving care or services
Patient Phone Number
For follow-up or doctor call
Section 3: Appointment Preferences
Choose your preferred appointment timeframe. Emergencies (24hrs) are prioritized, standard bookings are done within 48hrs, and flexible options (72hrs+) let you select a specific date.
24 Hours (Emergency)
48 Hours (Standard Booking)
72+ Hours (Flexible)
Section 4: Additional Details
Additional Notes / Special Requests
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