Copy all the below to email and filled in and send to: booking@healthscreening.sg ============================================================ Health Check Wellness Clinic Booking text form: ============================================================ NAME & IC ( As Indentity Card or Passport Number) : NRIC / Passport ( As Indentity Card or Passport Number) : Address : Dist Code: Gender : Gender:M/F Date of Birth: MM/DD/YYY Marital Status: Single, Marriage, other Citizenship : Nationality : Country From: Race : Languages spoken: Email: Handphone : Home Office: Appointment date Preferred: MM/DD/YYYY < - fill in the appointment date you preferred :) Monday to Saturday. ( 7 days in advance for all accept Standard Package basic screening for 3 working days in advance to make the booking ) Time slot preferred on the appointment date:- [ chose within 8.30am - 11.00] :- Package preferred for appointment: ## [ remove all the package content which not applicable to your preferred package( after filled in the package preferred ) ] ## Latest update on packages please refer to: http://www.healthscreening.sg/health_screening_Singapore_packages.html ## [ Package Selection : Select one of the package below within 1 - 21 & Remove the none applicable packages and leave the preferred package seleted. just leave the package and the serial number you preferred and remove the none applicable: Standard Packages 1. Standard Package Basic $135.00 2. Standard Package General Female $243.00 2a. Standard Package General Male $228.00 3. Standard Package General Female+Pap test $308.00 Deluxe Packages: 4. Deluxe Basic $308.00 5. Deluxe Men General $458.00 6. Deluxe Women General $468.00 7. Deluxe Women General + Pap smear $498.00 7a. Deluxe Men with Ultrasound abdomen $693.00 7b. Deluxe women with Ultrasound abdomen $715.00 7c. Deluxe Men with Treadmill $668.00 7d. Deluxe women with Treadmill $688.00 8. Deluxe Classic Women $765.00 9. Deluxe Premium Men $868.00 9a. Deluxe Premium Men Plus HIV $898.00 10. Deluxe Classic Premium Men $1,338.00 11. Deluxe Classic Premium women $1,398.00 Premarital : - 12. Deluxe Standard Female Premarital $368.00 13. Deluxe Standard Male Premarital $296.00 14. Female Deluxe Premarital Plus $620.00 15. Male Deluxe Premarital Plus $680.00 GP - Packages: 16. GP Basic $149.00 17. GP Basic Plus $249.00 18. GP General $299.00 Neighborhood Packages : 19. Neighborhood Clinic Deluxe Basic ( M/F ) $199.00 20. Neighborhood Clinic Deluxe General Female $358.00 21. Neighborhood Clinic Deluxe General Male $348.00 ] ## 21a. Deluxe Vital Men $338/- 21b. Deluxe Vital Women $388/- 22. Exclusive Deluxe Men $6988/- 23. Exlcusive Deluxe Women $7388/- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Venue of appointment prefer : " " < ( Chose from below info and fill it here in " " ) ## [ remove all the package content which not applicable to your preferred package( after filled in the package preferred ) ] ## For reference to chose the venue for your package please refer to and log in http://www.healthscreening.sg/health_screening_Singapore_venues.html to chose the entitle package that having for the venue available Pleasa select the package and the location you prefer : (Leave only location that you preferred & Remove the none applicable location in this email to avoid complication ) For latest updated details : Log in http://www.healthscreening.sg/health_screening_Singapore_venues.html Select one of 1 - 2, if you chose Standard package: ## [ 1. Paragon Orchard 2. Lucky Plaza Orchard Medical Center Select one of 3-6, if you chose Deluxe package: 3. Raffles Hospital - Bugis 3a. Thomson Medical - Novena 2 ( @Novena MRT) 4. Raffles Medical Clinic - Shenton Way One Raffles 5. Shaw House Orchard - Wellness Assessment Centre 5a. Somerset - HealthWay 6. Luck Plaza Orchard Medical Select one of 7 - 22, if chose Neighborhood deluxe package: 7.CENTREPOINT 8.CHANGI BUSINESS PARK 1 9.CLEMENTI 10.HOUGANG CENTRAL 11.JURONG EAST 12.MAPLETREE BUSINESS CITY - Pasir Panjang 13.MILLENIA WALK - Suntec 14.NEX - Serangoon 15.NORTHPOINT - Yishun 16.ONE MARINA BOULEVARD - Marina Boulevard 17.One Raffles - OUB Center Shenton Way 18.RAFFLES CITY 19.ROBINSON POINT 20.SIXTH AVENUE 21.TAMPINES ONE 22.Singapore Changi Airport T3 Select one of 23 & 24 if you chose GP package: 23. Kembagan 24. Camden - ( only post review report ) will deduct $15.00 ]## ---------------------------------------------------------------------------------------------------------------------------- All Packages All Deluxe, Premarital , GP , Neighborhood packages are with doctor review report. --------------------------------------------------------------------------------------------------------------------------- YOUR MESSAGE / Add on items / Entitle Option: ( Or if above particular is not yourself and you are booking for someone else, please leave your contact information of email & address & contact number below, stated the relationship between you.: Remark: ------------------------------------------------------------------------------------------------------------------------------ Take note: Payment mode available by Cash, Cheque, bank transfer i banking / e banking / paypal by credit card, paypal account, credit or debte card - these will depend on the package and location chose, will acknowledge you from our confirmation email. Terms of understanding: Once you submitted to us for the above detail for booking apppintment : mean you or person you help to book on behalf Deem to understand the screening profile, price that you are booking or booking on behalf, understand the terms stated in http://www.healthscreening.sg/terms.html and agreed the terms and refund policy.