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Contact Form

Contact us via form

All dear guests who have undergone surgery at Goharsa Surgery Center can complete the contact form (form below) and attach the scan of the necessary documents: (the picture of the national card and the picture of your written request in an image file up to the maximum size 2 megabytes with the listed permitted formats) and select the medical records unit in the relevant part of their application, to record the receipt of their hospitalization documents in this center so that their request will be answered as soon as possible by the relevant unit.

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    GOHARSA-FORM-LOGO
    Acceptance application form

    Self-assessment form for screening clients before admission to Goharsa Surgery Center

    GOHARSA-FORM-LOGO
    فرم درخواست پذیرش

    فرم خود ارزیابی جهت غربالگری مراجعین قبل از پذیرش در مرکز جراحی گهرسا

    برای تبدیل تاریخ به میلادی می توانید از این سایت استفاده کنید : ابزار تبدیل تاریخ