Please allow 1 working day for a confirmation on your appointment. It is also important to note that your request for an appointment is not confirmed until you receive a response from us. Please note that this is not a registration form to register you as a patient in the hospital. Thank you.

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Select Doctor

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Patient Full Name *

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Patient IC or Passport *

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Select Profession

Email *

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Is this appointment self-pay?
Yes
No

Company's GL or Insurance Policy

Direct Line No

+6089771873

Email

info.kmitawau@tdmberhad.com.my

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