Eu Yan Sang TCM Clinic Form

Book a TCM Clinic appointment:

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Please fill in patient's details:
We use this information to verify your identity, for existing patients; kindly enter the information registered with our clinics. For urgent appointments, please call our clinics.

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Name:^* NRIC / Passport No.:^* Mobile No.:^* Email Address^*(example@email.com) Reconfirm Email Address^*

Requested purpose of visit^*

Remarks

Kindly note that the suitability of the treatment varies according to the individual’s body constitution and will be subjected to our physician’s diagnosis after consultation, rather than by request.

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Thank you! Your booking is complete.

Your selected Physician

Your selected Clinic Location

Your selected Date

Your selected Time

Patient's Name

Patient's NRIC / Passport No.

Patient's Mobile No.

Patient's Email.

Patient's Purpose of Visit.