Complete this form to request an appointment at our medical centre. Our Patient Care Coordinator will contact you via phone or email to confirm the appointment.
Name E-mail Phone Number
Which of our services would you like to use?* GynaecologyCardiologyInternal MedicineGastroenterologyDay Care SurgeryOtorhinolaryngology (E.N.T)Ophthalmology
Which specialist would you like to see? (Optional) Dr. Mohd Hafaruzi Bin HarunDr. Omkara Rubini a/p P.V LinghamDr. Khoo Lee SengDr. Chua Wei SiongDr. Asokumaran A/L ThanarajDr. Shereen Shoba A/P Devaraj NairLt. Kol. (B) Datin Dr Omkara RubiniDr. Muhammad Daniel Soma Kumar bin AbdullahDr. Mohd Rahal YusoffDr. Sandev SinghDr. Gordon Pang Hwa MangDr. Wan Syahirah binti Yang MohsinDr. Mohammed Niraj bin Mohammed Feizal
Your Preferred Date (Optional) Your Preferred Time (Optional) 9.00am - 10.00am10.00am - 11.00am12.00noon - 1.00pm1.00pm - 2.00pm2.00pm - 3.00pm3.00pm - 4.00pm4.00pm - 5.00pm
By submitting this form I understand that Qualitas Health will protect my information in accordance to the Personal Data Protection Act 2010.
