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Surgery Booking Form
Please use this contact form to book a surgery slot.
Patient Name*
Patient NRIC / Passport*
Phone*
Email*
Nature of Operation
Date of Birth (dd/mm/yy)
Gender
Male
Female
Name of Clinic
Name of Staff
Date of Operation*
Time of Operation
Duration of Operation
Anesthesia Type (please select one)
LA
IV Sedation
GA
Name of Surgeon*
Name of Anesthetist
Special Instruction / Equipment Required
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