WhatsApp:
+60126377646
Tel: +60327870500
e-mail: info@altyortho.com
Radiology Second Opinion
Booking Form
Package/Service Option
*
:
Please select one
X-ray
CT Scan
MRI
CT Angiogram
Patient Status
*
:
New
Existing
MR No.:
Name (as per MyKAD/Kartu Tanda Penduduk/Passport)
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:
Birth date
*
:
MyKAD/Kartu Tanda Penduduk/Passport
*
:
Sex
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:
Male
Female
e-Mail
*
:
Mobile No.
*
:
Remarks:
Upload prescription, passport, etc. if any (only PDF, JPG and PNG files are accepted):
For Second Opinion Review, please provide your previous scans and reports for our Radiologist review.
How to upload file(s)?
I accept the
Terms & Conditions
*
Required information
Clear
Working Hours:
Monday to Friday
: 8:30am - 5:30pm
Saturday
: 8:30am - 1:00pm
