HOTLINE: +65 9296 9512

MRI EXAMINATION REQUEST FORM (For doctors use only)

Name:*
NRIC/PP:*
Birth Date:
Gender:
Tel:*
Address:
Test Required*:
Clinical Findings:
Patient's Next Appointment With Doctor:
Date:
Time:
Appointment Date:
Appointment Time:
Urgent appointment please call
Florence +65 9296 9512
Films/Report
Patient to Collect
Dispatch
Fax Report
Payment Mode
Pay at OHM
Bill Clinic
Bill Insurance
Doctor's Name & MCR No.:*
Clinic Stamp:
Date:
Female Patients: Pregnant
Patient's Signature:
Date:
Please submit the form online and also print a copy for patient to bring along to the clinic.
* Fields are compulsory to fill for submitting online, other fields can fill in after print out.
         

CONTACT US

ORTHOPAEDIC HAND MRI (OHM) ORCHARD PTE LTD

1 Orchard Boulevard #05-03
Camden Medical Center
Singapore 248649

Tel:+65 6732 1181
Fax:+65 6732 9971
Email:info@mri.com.sg

Opening Hours:
Monday - Friday: 8:30am to 6pm
Saturday: 8:30am to 1pm
Closed on Sunday & Public Holiday

Click here for direction

ORTHOPAEDIC & HAND MRI (OHM) EXTREMITIES PTE LTD

8 Sinaran Drive #05-18
Novena Specialist Center
Singapore 307470

Tel:+65 6339 3512
Fax:+65 6339 3912
Email:info@mri.com.sg

Opening Hours:
Monday - Friday: 8:30am to 6pm
Saturday: 8:30am to 1pm
Closed on Sunday & Public Holiday

Click here for direction

ORTHOPAEDIC & HAND MRI (OHM) NOVENA PTE LTD

8 Sinaran Drive #04-05
Novena Specialist Centre
Singapore 307470

Tel:+65 6268 6266
 +65 6268 6275
Fax:+65 6268 6271
Email:info@mri.com.sg

Opening Hours:
Monday - Friday: 8:30am to 6pm
Saturday: 8:30am to 1pm
Closed on Sunday & Public Holiday

Click here for direction