Teleconsultation registration form

Please choose type of Appointment

  

Are you already registered with FV?  
if YES, please fill in the information below
Incorrect HN
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Please enter the valid email
Your Appointment Information:

FV Hospital:

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

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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