Teleconsultation registration form

Are you already registered with FV?  
if YES, please fill in the information below
if NO, please fill in the information below
Incorrect HN
* This field is required Incorrect Phone Number
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Only .jpg, .jpeg are allowed. File must be less than 2MB

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Current Resident Address
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In Case of Emergency
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Medical Insurance
Occupation
Your Appointment Information:

FV Hospital:

Mon – Fri, 8:00 – 17:00,
Sat, 8:00 – 12:00

FV Clinic:

Mon – Sat, 7:30 – 12:00
Mon – Sat, 13:00 – 17:00

Choice Date Time
1st
2nd
Please provide the following information:

Only .jpg, .jpeg are allowed. File must be less than 2MB

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