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Appointment Information
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Patient's Name:
(as in NRIC/Passport)
Document Type:
Singapore Citizen
PR
Work Permit
Employment Pass
Others
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:
Acute Pain Services
Anaesthesiology
Advanced Laparoscopic Surgery
Breast Clinic
Care & Counselling
Cardiology
Chronic Pain Clinic
Clinical Epidemiology
Clinical Immunology Laboratory
Communicable Disease Centre
Complementary Integrative Medicine
Day Surgery Centre
Dental Clinic
Diabetes and Endocrine Centre
Diagnostic and Interventional Radiology Centre
Diagnostic Radiology
Digestive Disease Centre
Driving Assessment & Rehabilitation
Ear, Nose & Throat Clinic
Emergency Medicine
Endocrinology
Endoscopy Centre
Eye Centre
Foot Care and Limb Design Centre
Gastroenterology
Gastroenterology / Liver Clinic
General Medicine
General Surgery
Geriatric Medicine
GI Motility Laboratory/ Urea Breath Test
Haematology
Health Enrichment Centre
Hyperbaric Medicine Centre
Infectious Disease
Institute of Plastic Surgery (Singapore)
Invasive Cardiac Laboratory
Johns Hopkins Singapore International Medical Centre
Laboratory Medicine
LASIK Centre
Medical Oncology Clinic
Neurological Intensive Care Unit
Non-Invasive Cardiac Laboratory
Nuclear Cardiology Service
Nutrition & Dietetics
Occupational Therapy
Oncology Services
Oncology Services
Ophthalmology (Eye)
Orthopaedic Surgery Clinic
Outpatient Antibiotic Infusion Clinic
Pain Management Clinic
Pathology Medicine
Pharmacy Outpatient & Retail Pharmacy
Physiotherapy
Podiatry
Post-Anaesthetic Care Unit
Pre-admission Counselling & Evaluation
Prosthetics and Orthotics
Psychological Medicine & Psychology Services
Radiotherapy Centre
Radiation Oncology Clinic
Rehabilitation Medicine
Rehabilitation Medicine Clinic
Respiratory Medicine
Renal Unit
Respiratory Function (Pulmonary) Laboratory
Rheumatology, Allergy and Immunology
Smoking Cessation Clinic
Specialists Outpatient Clinic J
Speech Therapy
Sports Medicine Clinic
Surgical Intensive Care Unit
Travelers Health & Vaccination Clinic
TTSH Rehabilitation Centre
TTSH-NNI Trauma Training Centre
Urology
Vascular Surgical Services
If unsure of medical discipline, please specify medical conditions/symptoms:
Preferences
Preferred Appointment Date is between
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Jan
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Oct
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2009
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2015
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2018
2019
and
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Jul
Aug
Sep
Oct
Nov
Dec
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
in the
AM
PM
Preferred Days of the Week:
Mon
Tue
Wed
Thurs
Fri
Preferred Doctor: (if any)
Contact Information
Name:
E-Mail:
Phone[Home]:
Phone[Office]:
Handphone:
Pager:
Fax:
Please call between
8 am
9 am
10 am
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
and
9 am
10 am
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
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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