SIGN UP INFORMATION (AMENDMENT)
Note :In case of relocation/change of premises, please contact us at 03-8883 1310/1311 (for clinic) or 03-8883 1302/1304/1306 (for other than clinic)

Certificate of registration no.* :   
Title
:
Full name of applicant (as in NRIC)* :
NRIC no. of applicant* :  -   -  eg 811112 - 01 - 3344
Password* :   (six characters or more)
Re-type password* :   
Phone no.* : -
E-mail :   
Please remember your Application ID and Password.
One Application ID is valid for one (1) application only.

Please use a different Application ID for every application.