Annual Medical Check-Up

Annual Medical Check-Up
Employee Personal Information
Employee ID*
Name*

First NameLast Name
Email*
example@example.com
Mobile Number*
Gender*

MaleFemaleOthers
Date of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Annual Medical Check-Up
Appointment Details
Select Package*
This Package includes the below tests.

Home Collection Tests:

Complete Haemogram | Blood Group & RH Type | FBS | Total Cholesterol | SGOT / AST | SGPT / ALT | GGT | BUN | Urine(Routine) | Uric Acid

Center Visit Tests:

ECG | Complete Physical Examination by Physician & Consultation | Eye Checkup
This Package includes the below tests.

Home Collection Tests:

Complete Haemogram | Blood Group & RH Type | FBS | Total Cholesterol | SGOT / AST | SGPT / ALT | GGT | BUN | Urine (Routine) | Uric Acid | TSH

Center Visit Tests:

USG Abdomen & Pelvis | Complete Physical Examination by Physician & Consultation | Examination by Gynecologist & Consult (includes Breast examination) | Eye Checkup
This Package includes the below tests.

Home Collection Tests:

Complete Haemogram | Peripheral Smear | FBS | Total Cholesterol | HDL | LDL | VLDL | Triglycerides | LDL/HDL ratio | Cholesterol/HDL ratio | SGOT / AST | SGPT / ALT | GGT | Bilirubin (Total, Direct, Indirect) | ALP | Proteins (Total, Albumin, Globulin) | Creatinine | Urine (Routine) | Uric Acid | TSH

Center Visit Tests:

PPBS | USG Abdomen & Pelvis | TMT | Complete Physical Examination by Physician & Consultation | Eye Checkup
This Package includes the below tests.

Home Collection Tests:

Complete Haemogram | Peripheral Smear | FBS | Total Cholesterol | HDL | LDL | VLDL | Triglycerides | LDL/HDL ratio | Cholesterol/HDL ratio | SGOT / AST |SGPT / ALT | GGT | Bilirubin (Total, Direct, Indirect) | ALP | Proteins (Total, Albumin, Globulin) | Creatinine | Urine (Routine) | Uric Acid | TSH

Center Visit Tests:

PPBS | USG Abdomen & Pelvis | PAP smear | Sono Mammography | ECG | Complete Physical Examination by Physician & Consultation | Examination by Gynecologist & Consult (includes Breast examination) | Eye Checkup
This Package includes the below tests.

Home Collection Tests:

Complete Haemogram | Peripheral Smear | Hba1c | Total Cholesterol | HDL | LDL | VLDL | Triglycerides | LDL/HDL ratio | Cholesterol/HDL ratio | SGOT / AST | SGPT / ALT | GGT | Bilirubin (Total, Direct, Indirect) | ALP | Proteins (Total, Albumin, Globulin) | Creatinine | Urine (Routine) | Uric Acid | TSH | Stool Routine | PSA

Center Visit Tests:

USG Abdomen & Pelvis | TMT | 2 D Echo | Complete Physical Examination by Physician & Consultation | Eye Checkup
This Package includes the below tests.

Home Collection Tests:

Complete Haemogram | Peripheral Smear | Hba1c | Total Cholesterol | HDL | LDL | VLDL | Triglycerides | LDL/HDL ratio | Cholesterol/HDL ratio | SGOT / AST | SGPT / ALT | GGT | Bilirubin (Total, Direct, Indirect) | ALP | Proteins (Total, Albumin, Globulin) | Creatinine | Urine (Routine) | Uric Acid | TSH | Stool Routine

Center Visit Tests:

USG Abdomen & Pelvis | PAP smear | Radio Mammography | TMT | 2 D Echo | Complete Physical Examination by Physician & Consultation | Examination by Gynecologist & Consult (includes Breast examination) | Eye Checkup
Appointment City*
Home Collection Details
Home Collection Appointment Date*

DayMonthYear
Your center visit appointment will be after 3 days from home collection date.
Appointment Time*

7:30 AM - 8:00 AM8:00 AM - 8:30 AM8:30 AM - 9:00 AM
Centre Visit Details
Your centre visit appointment date is {date}
Date

DayMonthYear
Date
Select Centre in Bangalore*
Select Centre in Chennai*
Select Centre in Coimbatore*
Select Centre in Madurai*
Select Centre in Hosur *
Select Centre in Salem*
Select Centre in Trichy*
Should be Empty:

Annual Medical Check-Up

Employee Personal Information

Annual Medical Check-Up

Appointment Details

Home Collection Details

Centre Visit Details