DIY 1Pre-Admission Patient's Information

Step 1

Patient Information

Step 2

Next-of-Kin Information

Step 3

Claims & Payment

Step 4

Upload Documents

Step 5

Review Details

Patient's Information
* Mandatory fields

Reference No.

Admission Type*

Expected Date of Admission *

Name*

(as per NRIC / Passport)

ID Type*

ID No.*

Nationality*

Country of Residence*

Date of Birth*

Gender*

Race*

Marital Status*

Contact No. (Mobile)*

Contact No. (Home)

Occupation*

Religion*

Email Address

Home Postal Code (Only Singapore postal codes)

Billing Postal Code (Only Singapore postal codes)

Home Address*

Billing Address*

Same as home address

Specialty

Name of Doctor

Dr

Type of Delivery*

Ladies Card Member?*

Ladies Card Expiry Date