Appointment of Colonoscopy

Notice:

Thank you for your reservation request. Please note that is NOT a confirmed reservation. Our staff will confirm your consultation details by phone within ONE working day.
For any enquiries, you are welcome to contact our service hotline at 3405-8288.
The information provided by the applicant will be used for appointment only.

I. Services Day-case Colonoscopy

II. Personal Info

Titles Mr Mrs Miss

Chinese Name

English Name

Day of Birth Year 1 2 3 4 5 6 7 8 9 10 11 12 Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day

ID card No

Mobile No

Email

III. Appointment details

Preferred Date:

Timeslot AM PM

Alternative Date

Alternative Date AM PM

Have you ever join the Colorectal Cancer Screening Programme(CRCSP) before? YES No

Referral letter YES No

Have you had a Colonoscopy before? YES

No

Other Info