WhatsApp:
+60126377646
Tel: +60327870500
e-mail: info@altyortho.com
Doctor Tele-Consultation
Booking Form
FAQ
Package/Service Option
*
:
Please select one
Cardiologist (RM 150.00)
General Consultation (Physician/Internal Medicine) - Adult (RM 150.00)
Medical Officer (MO) - Adult (RM 20.00)
General Surgery - Adult (RM 150.00)
Dermatologist (RM 150.00)
Appointment date & time
*
:
Check Time Availability
Please select a date and time.
Patient Status
*
:
New
Existing
MR No.:
Name (as per MyKAD/Kartu Tanda Penduduk/Passport)
*
:
Birth date
*
:
MyKAD/Kartu Tanda Penduduk/Passport
*
:
Sex
*
:
Male
Female
e-Mail
*
:
Mobile No.
*
:
Tel No.:
Nationality
*
:
Malaysia
Australia
Bangladesh
China
France
India
Indonesia
Japan
Myanmar
Nepal
New Zealand
Pakistan
Philippines
Singapore
South Korea
Sudan
Thailand
United Kingdom
USA
Vietnam
Others
Address
*
:
Postcode
*
:
Occupation
*
:
Next-of-kin Name
*
:
Next-of-kin Contact No.
*
:
Company Name:
Remarks:
Upload results, prescription, passport, etc. if any (only PDF, JPG and PNG files are accepted):
I accept the
Terms & Conditions
*
Required information
Clear
Working Hours:
Monday to Friday
: 8:30am - 5:30pm
Saturday
: 8:30am - 1:00pm
