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I want to make an Health Screening appointment for:

*Available at Somerset only

For Elite, Premium, Excelsior & Platinum Packages, please choose 2 of the following tests:
- Abdominal Ultrasound
- Pelvis Ultrasound (For Female)
- Prostate Ultrasound (For Male)
- Treadmill ECG
- Bone Mineral Densitometry
- Mammogram (Recommended for Female 40 years old & above)
- Breast Ultrasound (Recommen

Optional Test

Remarks:

Patient's Particulars

Nationality: *

Patient's Name: *

Gender: *

Male

Female

Date of Birth: *

Passport No.: *

Telephone No.

Mobile No.: *

Fax No.

Email: *

Company Name:

Preferred Appointment Period:

1st:

2nd:

3rd:

Choose your Health Screening Centre

Healthway Screening & Wellness Centre 111 Somerset Road #05-02 TripleOne Somerset Singapore 238164

Healthway Medical Assessment Centre 10 Sinaran Drive Square, Novena Medical Centre #10-06/07 Singapore 307506

Additional Information

Others:

* We require these Mandatory Information to process your request.

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BOC Healthway Wellness Platinum Card