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Appointment Request Summary

Please check and confirm your details below before submitting appointment request

Appointment's Details

Hospital Location

Preferred Doctor

Specialty

Medical Concern/Request

Preferred Date

Preferred Time

Patient's Details

Patient's Name*

Date of Birth*

NRIC / Passport No*

Contact Number*

Email

Kindly note this is not a confirmed appointment
Our Pantai Customer Service team will contact you to finalize your appointment date & time based on doctor's availability.

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