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Maternity Booking

Complete the form below to book your maternity admission at Avenues Clinic.

1Patient
2Payment
3Employer
4Next of Kin
5Docs

Patient Details

Personal information of the patient

Telephone Numbers

Payment Information

Select your preferred mode of payment

Employer Details

Patient's employer information

Next of Kin

Emergency contact person details

Doctor's Information

Attach a scan of the page with the doctor's details