• Pre Register
Patients
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pre-registration

To save time at the clinic please complete and submit the following form:


An email address is required.
Your family name is required.
Your given name is required.
Day required.
Mth required.
Year required.
 
Your NRIC/FIN No is required.
Your Nationality is required.
Single    Married    Divorced    Defacto
Female    Male

Address Details

No    Yes
Your house or block number is required.
Your street is required.
Your city is required.
Your postcode is required.
Your Country is required.

Contact Details

Your home telephone number is required.
Your mobile telephone number is required.

Next of Kin

Day not valid.
Mth not valid.
Year not valid.
 

Direct Insurance Billing

Patient’s Consent Form

Miscellaneous

Please select the clinic you wish to visit.
Please select how you heard about us
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Contact Us

45 Rochester Park
Singapore 139249

+65 6776 2288
enquiries@chi-health.com.sg

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