Request To Make New/Follow-up Appointment

To make an appointment with NHG institutions, fill in the form below. Text boxes in red indicate required information and upon completion, click 'submit'.

Patient's name

NRIC/Birth Cert/Passport No

Medical discipline referred to

If unsure, specify medical conditions/symptoms

Referring source

Preferences

Preferred appointment date

Between and

Preferred time

Preferred day(s) of the week
(tick accordingly)

Mon Tue Wed Thurs Fri Sat

Preferred doctor (specify doctor's name or Nil for none)

Location

(clinic)
(hospital)

Contact Information

Requester's Name (enter name if requesting on behalf of patient)

Reply by
 (tick one only)

email
please call

Please bring the following on your visit:

  • Referral letter (on first visit)
  • Appointment card
  • NRIC or Passport (for first visit)
  • Other Documents as instructed


    • Private charges apply for the following referrals:
  • GP and Private Hospital
  • Self referrals
  • Private patients of Govt/Restructured Hospitals
  • Choice of doctor by name

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