WhatsApp:
+60174760866
Tel: +60327870500
e-mail: info@altyortho.com
COVID-19
Booking Form
FAQ
Package/Service Option
*
:
Please select one
Drive Thru COVID-19 RT-PCR Test (RM 280.00)
Drive Thru COVID-19 RT-PCR Test (Express) (RM 330.00)
Drive Thru COVID-19 RTK Antigen Test (RM 130.00)
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
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:
Next-of-kin Contact No.
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:
Remarks:
The following questions are mandatory:
1. Any history of travel?
*
:
Yes
No
2. Close contact with 'Confirmed COVID-19 patient'?
*
:
Yes
No
Upload 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
