Your Clinic Name

online

Clear this chat?

Messages and your saved details on this phone will be removed, and Mona will start fresh.

Messages are end-to-end encrypted. No one outside of this chat, not even WhatsApp, can read or listen to them.

secure.clinicforms.ae/register

Clinic

Patient registration

Takes about a minute. Your details are encrypted and stored by the clinic only.

Demo form. Nothing you enter is saved or sent.

Full name

Mobile number

Date of birth

Emirates ID number

15 digits, on the front of your card

Insurer

Member number

I consent to the clinic storing my details for my care and to be contacted about my appointments.

Encrypted in transit and at rest. This form is separate from your chat, so your ID and insurance details never appear in messages.

✓

Registration received

Returning you to the chat.

pay.clinicforms.ae/hold

Clinic

Secure your appointment

AED 100

This is a temporary hold on your card, not a charge. It is released after your visit, or if you cancel at least 24 hours before.

Demo payment. Test card only, no real charge.

or pay with card

Card number

Expiry

CVC

Card details go straight to the payment provider. The clinic and this chat never see your card number.

✓

Hold placed

Your slot is secured. Keep this reference for your records.

MH-000000