COVID-19 Tests at Home

Speedoc x Simply Sakal

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
Please select service

Please select your service*

Services

Video ConsultationAccess to doctors remotely and await complimentary medication delivery through a video call.

$15.00SGD

Doctor Home VisitMake an appointment with our certified doctors to receive professional medical care and advice at your home.

$144.50SGD

Nurse Home VisitMake an appointment with our experienced nurses to support your loved one’s activities of daily living, their wounds and more.

$59.50SGD

Baby VaccinationEarly immunisation gives your child the best protection against infections and diseases such as Hepatitis B, Polio and Tetanus.

$1,774.00SGD

Subtotal

$0.00SGD

Tax

$0.00SGD

Total

$0.00SGD

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

APPOINTMENT DETAILS
Date and Time - Video Consultation*
Test Date and Time - Doctor Home Visit*
Test Date and Time - Nurse Home Visit*
Test Date and Time - Baby Vaccination*
SURCHARGES

An additional late night charge of $30 is applicable for swabs performed between 8pm to 12 midnight daily.
An additional Public Holiday Surcharge of $50 is applicable for swabs performed on Public Holidays in Singapore.

Please note: All surcharges specified above are not included when making payment at the end of this order form. These charges will be due after your appointment slot has been confirmed by the Speedoc Team.
Remarks / Special Instructions (optional)
TERMS AND CONDITIONS

1. Speedoc will do our best to honour your selected appointment date & timing, but due to high demand, we may contact you to offer a different appointment time.

2. Patients are responsible for checking the testing window requirements of their specific event and if the clinic can meet the required timeline.

3. I authorise Speedoc to submit my particulars to the authorities for travel documentation purposes.

4. I acknowledge that my particulars submitted are accurate.

5. By proceeding, I agree that Speedoc shall not be held responsible for any delay due to inaccuracies in my submission.
*

I agree to the above Terms and Conditions
Clinic Address
8 Kaki Bukit Ave 1
#04-06
Singapore 417941
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