[SG] Dash Living x Speedoc

Dash Living x Speedoc

Please enter the details below and our team will get back to you with a confirmation soon.
PRIMARY CONTACT
Full Name (as in NRIC)*
NRIC/FIN/Passport No.*
Nationality / Citizenship*
Gender*
Date of Birth*

DayMonthYear
Mobile Number*
Email*
Appointment confirmation will be sent to this email
Home Address*

Street Address

Floor, Unit #, Building Name etc.

CityState / Province

Postal CodeCountry
TEST DETAILS
Please select COVID-19 Test Type

Please select your COVID-19 Test*

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Kindly provide your reason for booking a PCR Test:*
These services are not suitable if you are currently experiencing any respiratory symptoms. You can call us or download the Speedoc app to book an assessment for further evaluation in this scenario.
Other reason(s) for booking a PCR Test:*
This will help us advise you if the PCR test is the appropriate option for you.
Kindly provide your reason for booking an ART:*
These services are not suitable if you are currently experiencing any respiratory symptoms. You can call us or download the Speedoc app to book an assessment for further evaluation in this scenario.
Other reason(s) for booking an Antigen Rapid Test (ART):*
This will help us advise you if the ART is the appropriate option for you.
Brand of ART Kit:
Kindly prepare at least 2 un-opened, HSA-approved ART Kits
Batch / Lot Number for ART Kit:
Passport / Travel Document Number:*
This field is required if you would like to use the results from the selected test(s) as Pre-Departure documentation
ADDITIONAL PERSON(S) PARTICULARS
Total Number of Person(s)/Traveller(s)*
SECOND PERSON / TRAVELLER
Full Name (as in NRIC) - [Second Person]*
NRIC/FIN/ID No. - [Second Person]*
Passport / Travel Document No: - [Second Person]*
Date of Birth - [Second Person]*
Nationality / Citizenship - [Second Person]*
THIRD PERSON / TRAVELLER
Full Name (as in NRIC) - [Third Person]*
NRIC/FIN/ID No. - [Third Person]*
Passport / Travel Document No: - [Third Person]*
Date of Birth - [Third Person]*
Nationality / Citizenship - [Third Person]*
FOURTH PERSON / TRAVELLER
Full Name (as in NRIC) - [Fourth Person]*
NRIC/FIN/ID No. - [Fourth Person]*
Passport / Travel Document No: - [Fourth Person]*
Date of Birth - [Fourth Person]*
Nationality / Citizenship - [Fourth Person]*
FIFTH PERSON / TRAVELLER
Full Name (as in NRIC) - [Fifth Person]*
NRIC/FIN/ID No. - [Fifth Person]*
Passport / Travel Document No: - [Fifth Person]*
Date of Birth - [Fifth Person]*
Nationality / Citizenship - [Fifth Person]*
APPOINTMENT DETAILS
Test Date and Time - Home Swab*
Remarks / Special Instructions (optional)
TERMS AND CONDITIONS
1. A $30 surcharge applies for any scheduled nurse visit from 8pm to 8am.
2. A $50 surcharge applies for any scheduled nurse visit on a Public Holiday.
3. A $30 surcharge applies for any scheduled nurse visits to Sentosa, Jurong Island and Tuas.
4. Corporate programmes and other programmes are not applicable with these prices.
5. Rates are not applicable with other on-going promotions, discounts, offers, vouchers, rebates or privileges.
6. Speedoc’s General Terms and Conditions of Service(s) can be found at Terms of Use and may be amended from time to time.
7. For more information, contact our team at clinic.sg@speedoc.com or +65 6909 7799 .
*

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