Make An Appointment

To make appointment for Health Screening services at LUXE Wellness Centre for Women, please complete this online appointment form. Our female wellness concierge will contact you to confirm your appointment.

Patient's Particulars:
Nationality * :
Patient's Name * :
Date of Birth * :
Passport / NRIC * :
Telephone No :
Mobile No * :
Fax No :
Email * :
Patient's Current Medical Conditions / Symptoms / Diagnosis / Date of Last Day of Menstruation: *

Preferred Appointment Period:
Preferred date :
Alternative date :
Preferred Time Slot :
Additional Information:
Additional Remarks (i.e. Allergy and/or Dietary Requirements):
How did you get to know about LUXE Wellness Centre for Women?
Through friends/relatives Magazines
Through doctor's referral Internet
Newspaper Others:

* We require these Mandatory Information to process your request.