Name *

First

Last

We need your name.

Mobile Number *

For us to schedule appointments with with you via whatsapp.

Email *

For us to send you electronic copies of invoices or for other correspondences.

Home Address *

We need to document this as advised by MOH.

Date of Birth *

e.g. 12 Jul 1977 or 31 aug 2019 (this allows us to enter your age into the system).

Conditions *

eczema, atopic dermatitis, tsw, pompholyx eczema, facial eczema
psoriasis, psoriatic arthritis, inflammatory bowel disease, rheumatoid and other autoimmune conditions
genital herpes, bacterial vaginosis, herpes simplex, shingles, post-herpetic neuralgia,
respiratory conditions, allergic rhinitis, asthma, bronchitis, acute/chronic cough, acute/chronic sinusitis, unresolved cough
pain, musculoskeletal injury, vertigo, headache, neurodegenerative conditions (e.g. parkinson's, stroke)
others (please elaborate below)

Please elaborate here regarding your condition(s)

Preferred time slots *

e.g. Sat mornings, Mon/Tue/Fri lunchtime 12-130pm, evening 6-7pm, mornings before 1130am. (Even though it is not always possible, we will try out best to fit your preferences.)

How did you come to know about Chinese Doc Singapore?

Google search
Facebook
Online forums (please indicate below who referred you so we can thank them)
Referral (please indicate below who referred you so we can thank them)
Others (please elaborate below)

For elaboration?

We are a group of experienced TCM Doctors focused on treating skin conditions as well as allergic and autoimmune conditions using TCM.

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