connect facebook connect twitter connect weibo connect rss connect chinese
Banner Back Image
Online Corporate Health Check-Up & Vaccination Program Application
Service Type
Personal Information
Chinese Name: *
English Name: *
Date of Birth: //
Hong Kong IDCard: *
(Letter XXXX)
Gender: MaleFemale
Mobile No.: *
Email: *
Other Contact Person & Tel:
Reservation Information
Company Name: *
Service Plan Required: *
(If there are optional items, please indicate in selected items)
Selected Item(s):
Additional Add-Ons:
Preferred Date & Time of Check-up:
//
Alternative Date & Time of Check-up:
//
Remarks:
After making a reservation, you will receive a confirmation e-mail within 48 hrs. Please pay attention to your emails. Please present or print this e-profile at the time of your appointment.
If the requested appointment times are not available, Medifast Customer Service will e-mail or call you within 48 hours to change the time, if there are any questions please contact us at 22728222.
Core information must fill if the column with "*"