WELLNESS ASSESSMENT CENTRE

“Wellness is a Journey. Travel it well with AsiaMedic’s Health Navigators.”

MAKE AN APPOINTMENT (CORPORATE CLIENTS)

General Public | Corporate Clients

Part I: Personal Particulars
(bold - mandatory field)

Name

NRIC

Gender

MaleFemale

Company

Contact No.

(home)
(mobile)
(Office)

E-Mail

Part II: Appointment Information

Preferred Date

(dd/mm/yyyy)

Preferred Time

(hh:mm am/pm)

Alternate Date

(dd/mm/yyyy)

Alternate Time

(hh:mm am/pm)

Health Plan*

*depending on corporate policy

Part III: Authorisation Information

Name

Designation

Contact No.

(home)
(mobile/ pager)

E-Mail