Request an appointment

תפריט ראשי עליון

תפריט עמוד

Thank you for your interest in the Tel Aviv Sourasky Medical Center.

To request an appointment, complete and submit the information below. You will be contacted by phone within two workdays to schedule your appointment. You may also call the Tel Aviv Sourasky Medical Center Information Service at +972-3-697-4000 to schedule an appointment. Appointment Center hours are 8:00 – 19:00 Sunday through Thursday.

Personal DetailsRequired Fields*

*First Name

First Name {{ClubFormCtrlAlias.ValidationObj.required}}

First Name - {{ClubFormCtrlAlias.ValidationObj.textBoxChars}}

First Name - {{ClubFormCtrlAlias.ValidationObj.inputToShort}}

First Name - {{ClubFormCtrlAlias.ValidationObj.FirstNameTooLong}}

*Last Name

Last Name {{ClubFormCtrlAlias.ValidationObj.required}}

Last Name - {{ClubFormCtrlAlias.ValidationObj.textBoxChars}}

Last Name - {{ClubFormCtrlAlias.ValidationObj.inputToShort}}

Last Name - {{ClubFormCtrlAlias.ValidationObj.LastNameTooLong}}

*Israeli ID number

Israeli ID number {{ClubFormCtrlAlias.ValidationObj.required}}

Israeli ID number - {{ClubFormCtrlAlias.ValidationObj.GovermentIdTooLong}}

*Phone

Phone {{ClubFormCtrlAlias.ValidationObj.required}}

Phone - {{ClubFormCtrlAlias.ValidationObj.PhoneTooLong}}

Phone 2

Phone 2 - {{ClubFormCtrlAlias.ValidationObj.phoneError}}

Phone 2 - {{ClubFormCtrlAlias.ValidationObj.MobilePhoneTooLong}}

*City

City {{ClubFormCtrlAlias.ValidationObj.required}}

City - {{ClubFormCtrlAlias.ValidationObj.textBoxChars}}

City - {{ClubFormCtrlAlias.ValidationObj.inputToShort}}

City - {{ClubFormCtrlAlias.ValidationObj.CityTooLong}}

*Street

Street {{ClubFormCtrlAlias.ValidationObj.required}}

Street - {{ClubFormCtrlAlias.ValidationObj.textBoxChars}}

Street - {{ClubFormCtrlAlias.ValidationObj.StreetTooLong}}

*Home number

Home number {{ClubFormCtrlAlias.ValidationObj.required}}

Home number - {{ClubFormCtrlAlias.ValidationObj.number}}

Home number - {{ClubFormCtrlAlias.ValidationObj.HouseNumberTooLong}}

ZIP Code

ZIP Code - {{ClubFormCtrlAlias.ValidationObj.number}}

ZIP Code - {{ClubFormCtrlAlias.ValidationObj.PostCodeToShort}}

ZIP Code - {{ClubFormCtrlAlias.ValidationObj.PostCodeTooLong}}

*Email

Email {{ClubFormCtrlAlias.ValidationObj.required}}

Email - {{ClubFormCtrlAlias.ValidationObj.EmailTooLong}}

* Email receipt approval consent to receive emails from the Medical Center(related to my contact request – not advertising or marketing material)

Appointment information

Contact information

*Purpose

Purpose {{ClubFormCtrlAlias.ValidationObj.required}}

*Unit

Unit {{ClubFormCtrlAlias.ValidationObj.required}}

Contact information

Doctor name

Doctor name - {{ClubFormCtrlAlias.ValidationObj.textBoxChars}}

Doctor name - {{ClubFormCtrlAlias.ValidationObj.inputToShort}}

Doctor name - {{ClubFormCtrlAlias.ValidationObj.DoctorNameTooLong}}

Contact name

Contact name - {{ClubFormCtrlAlias.ValidationObj.textBoxChars}}

Contact name - {{ClubFormCtrlAlias.ValidationObj.inputToShort}}

Contact name - {{ClubFormCtrlAlias.ValidationObj.ContactNameTooLong}}

Phone

Phone - {{ClubFormCtrlAlias.ValidationObj.inputToShort}}

Phone - {{ClubFormCtrlAlias.ValidationObj.ContactPhoneNumberTooLong}}

*Message

{{500 - ClubFormCtrlAlias.Join.Description.length}} characters remaining of 500

Message {{ClubFormCtrlAlias.ValidationObj.required}}

Message - {{ClubFormCtrlAlias.ValidationObj.FreeText}}

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