Registration for COVID-19 On-site Screening Services

Are you already registered with FV?  
if YES, please fill in the information below
if NO, please fill in the information below
Personal information
* This field is required
* This field is required
* This field is required
* This field is required
* This field is required
* This field is required
* This field is required




Only .jpg, .jpeg are allowed. File must be less than 1MB

* This field is required
Current Resident Address
* This field is required
* This field is required
* This field is required
* This field is required
* This field is required
In Case of Emergency
* This field is required
* This field is required
Medical Insurance
Occupation

Please provide the following information
* This field is required
Have you been in close contact with a person with confirmed COVID-19?
* This field is required
Have you been in quarantine or attended an event associated with known COVID-19 outbreak in the past 14 days?
* This field is required
Please specify date of onset for each symptom / Specify if within the past 14 days, you have:







* This field is required
* This field is required
For consultations, kindly contact our Call Centre
Hotline: 0962 62 78 26
Monday – Friday: 08:00 -- 17:00
Saturday: 08:00 -- 12:00
Sunday & Public Holiday: Closed