Health Screening Appointment

Personal Particular

Name

Date of Birth

Gender

Nationality Work Pass

NRIC / FIN

Passport Number

Mobile Number

Alternative Contact Number

Full Company Name

Contact Person's Particulars, If Different From The Above

Name

Mobile Number

Alternative Contact Number

Appointment Details

Health Screening Package

Preferred Appointment Date

Clinic Location

Alternative Appointment Date

Remarks

I agree to the terms of use and IHH Singapore Data Protection Notice and consent to the use of my personal data given above to process follow-up actions to provide a seamless patient experience, including but not limited to confirming my appointment etc.

I also consent to IHH Healthcare Singapore, their representatives, agents and/or business partners collecting, using and disclosing my personal data for marketing and promotional purposes (described as "Additional Purposes" in the IHH Singapore Data Protection Notice). I understand that I may withdraw such consent at any time. I agree to receiving marketing messages via SMS, telephone call and other Singapore phone number-based messaging, regardless of my registration with the Do-Not-Call registry.

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