Health Screening Centre | Hospital Lam Wah Ee

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

Health Screening Online Registration Form

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Personal Details

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