Information for Ukrainian refugees / Інформація для українських біженців (click here)
Information for Ukrainian refugees / Інформація для українських біженців (click here)

CLERMONT HEALTH Application Form

Please fill out all fields before submitting this form and verify that all information provided is accurate and complete to help expedite your application in a timely manner.

Please note this is an application and does not automatically entitle you to registration at our clinic. Our applications are reviewed on a six weekly basis and you will not hear from us until your application is reviewed. If you have an acute medical issue please attend the local emergency department.

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08 04 1967
042 9312345
086 1234567
05 04 2025