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General Pre-Screening Questionnaire

New Path Medical & Aesthetics

Hi there! We're looking forward to being a part of your health screening journey.

Please take some to complete this questionnaire with your medical information as a pre-screening procedure to help us better understand your results!

Name

*

NRIC (Last 4 Characters)

*

Biological Gender

*

Ethnicity

*

Date of Appointment/Sceening

*

Package Selected

*

Any add-ons?

*

Did you fast overnight before the health screening (min. 10-12 hours)?

*

A

Yes

B

No