Tan Tock Seng Hospital - Making An Outpatient Appointment

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**Patient's Name:
(as in NRIC/Passport)

**Patient's NRIC / Passport No:

Private charges apply for the following referrals made through:
1. Choice of Doctor by Name
2. GP and Private Hospital
3. Self referrals
4. Private patients of Govt/Restructured Hospitals

GP (Please specify clinic & contact no.)

Another hospital
(Please specify hospital & contact no.)

Self referral

Medical Discipline referred to:

If unsure of medical discipline, please specify medical conditions/symptoms:

Preferences

**Preferred Appointment Date is between

and
in the

Preferred Days of the Week:

Mon Tue Wed Thurs Fri

Preferred Doctor: (if any)
Please specify name of Doctor
Private charges apply for referrals to the Doctor by Name

Contact Information

Name:

E-Mail:

Phone[Home]:

Phone[Office]:

Handphone:

Pager:

Fax:

Please call between

and

For information on what to bring for the first out-patient consultation, please click here

Please ensure information is correct for a hassle-free submission

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