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Patient Intake Form

Personal Information

To ensure you receive the best possible care, please complete the form below with your personal and medical information. We wish you a healthy and fulfilling life.

Sex
Male
Female
Social Status
Single
Married
Divorced
Widow
Prefer not to say

Nationality
Jordanian
Other

Add your country code first, followed by your number.

Example: +962 7XXXXXXXX

Are you the owner of this phone number?
Yes, me
No, it belongs to someone else
Who referred you to our clinic?
A Medical Doctor
Social Media (Google, Facebook, etc)
A friend or parent
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Dr. Basel Masri is a Senior Consultant Rheumatologist at Jordan Hospital in Amman, specializing in rheumatic and musculoskeletal conditions. He holds key roles in major rheumatology associations.

Quick Links

Opening Hours

Saturday, Monday

& Wednesday​

16:00-18:30

09:30 -13:30

09:30-16:00

09:30-13:30

Closed

​Sunday, Tuesday

Thursday

Friday

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