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Ng Teng Fong General Hospital
Jurong Medical Centre
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Appointment Request Form
Appointment Request Form
Fill up the form below if you wish to make a new appointment, change or cancel your appointment.
Note: Fields marked with an asterisk (*) are required fields.
Note: Fields marked with an asterisk (*) are required fields.
Note: Fields marked with an asterisk (*) are required fields.
I wish to*
Select One
Make an Appointment
Change an Appointment
Cancel an Appointment
Personal Particulars
Full Name*
NRIC/FIN No.
Please fill in this field if you are Singaporean, PR or foreign citizen working in Singapore.
Passport No.
Please fill in this field if you are a foreigner who is not working or living in Singapore.
Email*
Salutation*
Mr
Ms
Mrs
Mdm
Gender
Male
Female
Date of Birth*
Please enter in DD/MM/YYYY format.
Please fill in at least one contact number.*
Mobile No.
Residential No.
Office No.
Your Address
Block/House No.*
Street*
Unit No.
Building Name
Postal Code*
Make an Appointment
Description of Medical Conditions / Symptoms
1500 characters remaining
Preferred Date
Please note that our clinics do not operate on weekends and public holiday.
Preferred Timing
Morning
Afternoon
Please call me between Monday to Friday
From
Select One
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
To
Select One
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
Security Verification
Please enter the case-sensitive text as seen in the image in the text box provided.
Reset
Personal Particulars
Full Name*
NRIC/FIN No.
Please fill in this field if you are Singaporean, PR or foreign citizen working in Singapore.
Passport No.
Please fill in this field if you are a foreigner who is not working or living in Singapore.
Email*
Salutation*
Mr
Ms
Mrs
Mdm
Please fill in at least one contact number.*
Mobile No.
Residential No.
Office No.
Change Appointment
Details of Original Appointment
Clinic*
Original Date for Appointment*
Original Time for Appointment*
Select Hour
AM 8
AM 9
AM 10
AM 11
PM 12
PM 1
PM 2
PM 3
PM 4
PM 5
Select Minutes
00
05
10
15
20
25
30
35
40
45
50
55
Schedule a New Appointment
Preferred Date
Please note that our clinics do not operate on weekends and public holiday.
Preferred Timing
Morning
Afternoon
Please call me between Monday to Friday
From
Select One
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
To
Select One
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
Security Verification
Please enter the case-sensitive text as seen in the image in the text box provided.
Reset
Personal Particulars
Full Name*
NRIC/FIN No.
Please fill in this field if you are Singaporean, PR or foreign citizen working in Singapore.
Passport No.
Please fill in this field if you are a foreigner who is not working or living in Singapore.
Email*
Salutation*
Mr
Ms
Mrs
Mdm
Please fill in at least one contact number.*
Mobile No.
Residential No.
Office No.
Cancel Appointment
Details of Original Appointment
Clinic*
Original Date for Appointment*
Original Time for Appointment*
Select Hour
AM 8
AM 9
AM 10
AM 11
PM 12
PM 1
PM 2
PM 3
PM 4
PM 5
Select Minutes
00
05
10
15
20
25
30
35
40
45
50
55
Security Verification
Please enter the case-sensitive text as seen in the image in the text box provided.
Reset
