[MY] Elderly Care

Elderly Care

Please provide your details below and our team will get back to you with confirmation soon.
Patient's Details
Name*
NRIC/Passport Number*
Gender*
Date of Birth*

DayMonthYear
Email*
Appointment confirmation will be sent to this email
Contact Number
Emergency Contact Number
Do you have any allergies to any medications?*

YesNo
Please describe your allergies:*
On-Site Treatment Address*

Street Address

Floor, Unit #, Building Name etc.

CityState / Province

Postal CodeCountry
APPOINTMENT DETAILS
Do you have a preferred date and time for your first appointment?

YesNo, I will inform Speedoc when I am contacted.
Preferred Date & Time - [subject to availability]*

Products

Get Started Geriatric Care PackageA comprehensive service from a geriatrician and dietitian to manage the overall health and well-being of the elderly at home.

600.00MYR

Vital health screening packageA test that looks at key health indicators to detect potential health issues.

150.00MYR

Enter coupon

Subtotal

0.00MYR

Tax

0.00MYR

Total

0.00MYR

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

TERMS AND CONDITIONS
1. A surcharge of RM50 to RM100 applies for any scheduled home visit that falls on a public holiday.
2. A surcharge of RM50 to RM120 applies for any scheduled home visits outside of Speedoc’s service coverage.
3. Prices differ for individuals under existing corporate programmes and other promotional packages.
4. Promotional rates stated are non-stackable with ongoing discounts, offers, vouchers, rebates or other privileges.
5. Speedoc’s Terms of Use and Privacy Notice apply.
6. For more information, contact our team at contact.my@speedoc.com or +6011 4166 1178.
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Elderly Care

Patient's Details