Registration for Health Screening Appointment

Registration For Health Screening Appointment

Register for your chosen Health Screening Package by filling out the details below.
Health Screening Package
Cardiology Test Clinic : Location - Mount Elizabeth Medical Centre
Blood Test Clinic : Location - The Paragon 290 Orchard Road
Date of screening

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Time of screening
Lunch time (1pm - 2pm)
Full Name (as per NRIC)
ID Type
ID Number
Nationality
Gender
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Contact Number
Please enter a valid Singapore phone number.Format: 00000000.
Email Address

Confirmation Emailexample@example.com
Full Address

If you have signed up for blood test the results will be mailed to the address above.

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Message
Company Details (if applicable)

*Please complete this section only if you are company-sponsored
Company Name
Please enter the name as per ACRA
Contact Person Name
Contact Person Number
Please enter a valid Singapore phone number.Format: 00000000.
Contact Person Email Address
example@example.com
Your personal data submitted under this form may be used to send you notices, information, promotions and updates including marketing and advertising materials in relation to goods and services of Learners Hub Pte Ltd and its business partners, and for research and analysis.
Marketing Consent - I agree to authorise Learners Hub Pte Ltd in contacting me about Learners Hub programs and follow up messages.
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Registration For Health Screening Appointment

Company Details (if applicable)