Medical Report Application

Please complete the requirement application to ease the application process.

Any question or problems, freely contact us at:
03-55151871 (Avisena Specialist Hospital)
03-55151888 ext 20711 (Avisena Women's & Children's Specialist Hospital)
* Indicates required question

We will inform you when your application has been received



if patient is below 18 years old, NRIC parents is required

Representative, agent, lawyer etc is required

Please upload PDF file only. You can upload multiple files
Consent to release information
You must agree before submitting.