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Parent / patient full name *

Phone / WhatsApp number *

Email address (optional)

Patient / child age (optional)

Which service are you interested in? *
— Select a service —Pediatric & Functional Medicine ConsultationDevelopmental-Behavioral PediatricsAutism Assessment & SupportADHD & Attention SupportSpeech, Language & FeedingOccupational & Sensory TherapyApplied Behavior Analysis (ABA)Early Intervention & School ReadinessSpecialized Assessment & PsychometryAcademic & Learning SupportChild Psychology & Parenting ProgramTherapeutic NutritionFunctional Blood TestsNeurofunctional & Device-Based AssessmentIntegrated ProgramHome Visit TherapyExosomes — Medical InformationOnline ConsultationOther / Not sure

Preferred doctor (optional)
— Preferred doctor —Dr Mohamed Afify — Pediatric Consultant & Functional MedicineDr Ehab El Emam — Consultant Pediatrician & NeonatologistDr Mai Mohamed Ghazy — Pediatric Consultant, Speech & FeedingDr Ahmed Ramzy — Consultant Developmental-Behavioral PediatricianNo preference / please advise

Preferred visit type (optional)
— Preferred visit type —In-clinic (New Cairo)Online consultationPlease advise

Preferred date (optional)

Best time to contact you (optional)
— Best time to contact you —Morning (10am – 12pm)Afternoon (12pm – 4pm)Evening (4pm – 9pm)

How did you hear about us? (optional)
— How did you hear about us? —Google SearchSocial Media (Instagram / Facebook)Friend or Family ReferralDoctor ReferralSchool / NurseryOther

Reason for consultation (optional)

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* I consent to Spectra using the health-related information I submit to coordinate this enquiry and appointment.

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Medical emergency? Do not use this form. Call the Egyptian ambulance service on 123 or go to your nearest emergency department.