Make an appointment Appointment Form General InformationName*Phone Number*Email Clinic Location*Ang Mo KioChoa Chu KangService*General consultationHealth screeningAesthetics servicesVaccinationPap SmearPast HistoryDo you have hypertension?NoYesAre you on medication for Hypertension?NoYesDo you have Diabetes?NoYesAre you on medication for Diabetes?NoYesDo you have high Cholesterol?NoYesAre you on medication for high Cholesterol?NoYesDo you have Asthma?NoYesDo you have any other medical problem(s)?NoYesPlease specify Family HistoryDo you parents have Diabetes?NoYesHow many years?Do you parents have high Cholesterol?NoYesDo you parents have Hypertension?NoYesDoes any of you parents had Stroke?NoYesAppointment PreferencesDoctor PreferencesNo preferencesFemaleMalePreferred appointment date* Time : HH MM AM PM Promo code