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Online Registration Form

Health Screening Online Registration Form

We offer advanced booking and registration services. Kindly fill up the pre-registration form for advanced registration purpose.

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Personal Details

Please allow 3 working days for us to process your appointment. Once it is done, we will send you a confirmation email. Please be reminded to bring along your original IC or Passport on the screening day.

Email Address *

@

Medical Check-up Date *

Patient's Name (Follow exact name in NRIC or exact name in Passport) *

Date of Birth*

NRIC / Passport No. *

Age *

Telephone No. / Handphone No. *

Gender *

Male

Female

Marital Status *

Single

Married

Divorced

Widowed

Race *

Religion *

Nationality *

Malaysian

Singaporean

Indonesian

Other

Address*

Postcode *

City *

State *

Country *

Occupation*

Payment Mode *

Self Pay

Corporate

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EMERGENCY CONTACT DETAIL

Next of Kin's Name (Emergency Contact Person Name)*

NRIC / Passport No. *

Telephone No. / Handphone No. *

Gender *

Male

Female

Email Address

@

Address

Postcode

City

State

Country

Relationship*

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PACKAGE SELECTION

Package Selection *

BASIC Package

ESSENTIAL Package

ENHANCED Package

China Entry Screening

Korea Entry Screening

Japan Entry Screening

Pre-University Screening

Pre-Employment Screening

Customized Corporate Screening

Malaysia My Second Home Programme Screening

Body Composition Analysis (BCA) with Dietitian

Lung Cancer Screening

Osteoporosis Screening Package

Other

Optional Screening Tests

Anti - HIV I & HIV II

VDRL

HEPATITIS A lgG

Glaucoma Screening

Lung Cancer Screening - CT Thorax

Lung Function Analysis

3D Digital Mammogram - Female > 40 yrs

Pap Smear + Ultrasound Pelvis by Consultant Gynaecologist

DEXA Bone Scan (Hip and Spine) - > 50 yrs

Stool for Occult Blood

Healthy Dietary and Lifestyle Advice by Dietitian

Body Composition Analysis

Cancer Markers

Tumour Marker CA 15.3 (screening for breast tumour)

Tumour Marker CA 125 (screening for ovary tumour)

Tumour Marker CA 19.9 (screening for pancreas tumour)

Carcinoembryonic Antigen CEA (screening for colon tumour)

Alpha Feto Protein (screening for liver tumour)

Prostate Specific Antigen (PSA)(screening for prostate tumour)

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