Appointment Form

Name :

Company Name :

Sex :

Nationality :

Address :

City:

Postcode:

State:

Others (overseas):

Contact No. :

Office No.

Mobile No.

E-mail :

Selected Package :

	Executive
	Heart
	Heart + Cancer
	Heart + Cancer + Bone Scan
	Heart + Stroke +Cancer + Bone Scan

My preferred
appointment date :

My preferred
appointment time :
Opening hours
Mon to Fri 8.30am — 5.30pm
Sat 8.30am — 1.00pm

Remark :

	HSC MEDICAL CENTER Lot 3.6, Level 3, PNB Darby Park, 10 Jalan Binjai, 50450 Kuala Lumpur, Malaysia. (Location Map) TEL: +60-3-2712 0866 FAX: +60-3-2712 0766 info@hsc.com.my

The information is provided for education purpose only and is not intended to represent the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about specific medical condition or contact HSC Medical Center.