Patient Referral Form

    To refer patient to our doctors, please fill up the form below. Thank you.


    Dato’ Dr. Colin LeeDr. Haris HamzahDr. Lam Wei KianDr. Leong Wai YewDr. Navdeep Singh PannuDr. Tan Chong SeongDr. Wan Syahirah Yang MohsinDr. Wilkinson TanDr. Melanie Kuan Lih JiunDr. R.M. Udayar Pandian RamachandhiranOthers

    Patient's Particular


    CLINICAL INFORMATION


    REASON FOR REFERRAL

    Fertility Assessment (Inc. Semen Analysis, Abdomen Scan and Transvaginal Scan)Intrauterine Insemination (IUI)Preimplantation Genetic Testing (PGT)In vitro fertilization (IVF)Gynaecology UltrasoundMale InfertilityEgg FreezingOthers

    REFERRING DOCTOR'S INFO


    For more information contact:

    G01, Ground Floor, Encorp Strand Mall, Jalan PJU 5/22, Kota Damansara, 47810 Petaling Jaya, Selangor, Malaysia

    Tel: +603-6141 6166 / +6014-941 6388 (to make appointment)

    Thank you.

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