RNTBCI Health Check Form

Employee Health Check Appointment Details
Name*
Gender*
Company Name*
Date of Birth*

DayMonthYear
Date
Age
Enter 'Date of Birth' to auto calculate age
Phone Number*
Please enter a valid phone number.
Email*
emailid@gmail.com
Employment Type*

On RollOff Roll
Work Location*
Government ID proof - Pan card*

Allowed file formats pdf, jpg, jpeg, png
Cancelof
Preferred Location For Health Check*
Preferred Location For Health Check*
Key Guidance
1. Please note that weekends are heavy booking days at the center.
2. Recommend 1 Weekend preference and 1 weekday options.
3. Sunday is a holiday.
4. Packages have been curated based on collaboration with Health and Safety and HR teams.
5. No Shows will be considered as appointment cancelled.
6. Skipping out of any of the modalities during the day of the test will be shown as BLANK in the report for those modalities.
Preferred Date 1*

DayMonthYear
Weekends and weekdays can be selected
Preferred Time 1*
Preferred Date 2

DayMonthYear
Only weekdays can be selected
Preferred Time 2
Submission Date

DayMonthYear
Date
Timestamp and location
Please verify that you are human*
Should be Empty:

Employee Health Check Appointment Details