Appointment Online Form Submission

Making/Changing Your Appointment for Consultation through WWW
 

Kindly fill out the appointment form. Only completed forms will be processed.
Date of appointment requested must be at least 5 working days from the
date of booking.

Please refer to page on Consultation Fees.
 

Transaction required * Booking   Changing   Cancelling
Name *
NRIC *
Gender Not specified   Male   Female
Birthdate *
Nationality *
Home Address *
Email *
Ethnic Group *
Contacts No. Mobile / Residence / Office
Main Contact *
Alternate Contact 1
Alternate Contact 2 
Date/Time Of Original Appointment ( If applicable )
Date
Time
Date/Time Of Appointment Requested ( Monday - Friday )
Date
Time
Any specific doctor?    List Dermatologists
Letter of Referral? Yes - General Practitioner    Yes - Government Polyclinic/Hospital/Institution     No
First visit to NSC? Yes   No
Remarks
   
Verification Code *
Type the letters you see in the picture below, letters are not case-sensitive.
   
* Required fields

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