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Kindly note that this registration form is NOT a confirmation of your health screening appointment. A hospital representative will be in touch with you to confirm your booking. 

The fields with “*” are compulsory. 

* Required fields

Full name: *

IC / Passport Number: *

Age: *

Mobile: *

House line:

E-mail: *

Selected Health Screening Package: *

Where did you find out about this health package? FacebookWebsiteOther

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