Health Screening Registration Form

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+65 6708 8000

+65 8222 8488

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Registration Form
(Health Screening-Corporate)

Please answer accordingly.

Company Name / Department

Full Name

NRIC / FIN / Passport

Singapore Residential / Hotel Address

Date of birth * required

Nationality

Gender

Phone number (with country code)

Last menses / period (female)

Drug allergies

if you answered (YES) to Drug Allergy

01. Please select If YOU have any of these conditions * Обязательно

High Cholesterol

Heart Disease

Hypertension

Diabetes

Stroke

Cancer

Kidney Disease

Liver Disease

Asthma / Lung Disease

Thyroid

Auto-immune Disease

Bleeding Disorder

HIV

Others

NONE OF THE ABOVE

02. Please select if YOUR FAMLY have any of these conditions * Обязательно

High Cholesterol

Heart Disease

Hypertension

Diabetes

Stroke

Cancer

Kidney Disease

Liver Disease

Asthma / Lung Disease

Thyroid

Auto-immune Disease

Bleeding Disorder

HIV

Others

NONE OF THE ABOVE

01A. if you answered (YES or OTHERS)

02A. if your FAMILY have any of the conditions

03. Lifestyle * Обязательно

Currently on medication

Smoking

Alcohol Consumption

Exercise

Contraception

NONE OF THE ABOVE

03A. if you have any of the conditions

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Precious Medical Centre

290 Orchard Road, #12-01 Paragon Medical

(Lobby E & F), Singapore 238859

Monday to Friday 8:30am - 5:30pm

Saturday 8:30am - 12:30pm

Closed on Sundays & Public Holidays.

The schedule and availability of our GP doctors may change without prior notice. Last GP appointment on weekdays is 3:30 pm, no GP appointments on Saturdays. Please contact us for the updated schedule.

Enquire now

Book Appointment

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Contact Details

+65 6708 8000

+65 8222 8488 (WhatsApp)

enquiry@preciousmed.com

Precious Medical Centre

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Registration Form (Health Screening-Corporate)

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Registration Form
(Health Screening-Corporate)