Appointments – IJNPRIVATE

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1Your Details

2Appointment Details

PATIENT NAME*
DATE OF BIRTH –*

DD slash MM slash YYYY
GENDER*
- Male
- Female
NRIC/PASSPORT #*
NATIONALITY*
MOBILE #*
YOUR EMAIL*
ADDRESS*

Street Address

City

State

Postcode

Country
PATIENT'S CURRENT MEDICAL CONDITIONS / SYMPTOMS / DIAGNOSIS (If any)
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Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

PREFERRED APPOINTMENT DATE
From*

DD slash MM slash YYYY
To*

DD slash MM slash YYYY
PREFERRED TIME SLOT*
PREFERRED SPECIALIST*
- Cardiologist
- Cardiothoracic surgeons
- Pulmonologist
- Endocrine physician
- Cardiothoracic others
- Nephrologists
- No preference
Cardiologist*
cardiothoracic surgeons*
Pulmonologist*
Endocrine physician*
Cardiothoracic others*
Nephrologists*
DO YOU NEED AIRPORT TRANSPORT?*
- Yes (Fees Apply)
- No
PAYMENT METHOD*
- SELF PAY
- INSURANCE
- OTHERS (PLEASE SPECIFY)
INSURANCE*
Insurance Details, Please Specify*
IF OTHERS; PLEASE SPECIFY*
Upload any relevant document*
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.
Agreement*
- I’ve read and agree to the IJN’s terms and condition and privacy policy

CONTACT CENTRE

+603 2617 8844
(Mon to Fri 8.30am–4.45pm)

WHATSAPP APPOINTMENTS

+60 19-319 5223

MOBILE APP

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"Beyond Cardiac Excellence” signifies our believe in delivering not only excellent cardiac care but providing holistic approach to all our customers as a whole.

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