Appointment Booking Form

Select Your Service
Please choose the service(s) you’d like to book:*
Preferred Appointment Date & Time*
Personal Information
Name*

First NameLast Name
Phone Number

Country CodePhone Number
Email*
example@example.com
Gender
Preferred Contact Method*

EmailPhoneLINEWhatsApp
Client Details

To help us provide the best experience, please tell us a bit about yourself:
Are you a returning client?*

YesNo
Purpose of Visit

Regular Health Check-UpPreventive Care (e.g., PrEP/PEP, STI Testing)Wellness & Recovery (e.g., IV Hydration Therapy)Other
How did you hear about us?*

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Privacy Acknowledgment
Your information will remain confidential and secure.*

I agree to SHIELD Medical Center’s privacy policy.
Book My Appointment
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Select Your Service