Referral Form

Do you have any specific question on IVF, ICSI or IUI?

Note: Please do not use this form to arrange appointments or request reports. Instead, kindly call this number +603 2780 4288.

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PERSONAL DATA USE CONSENT*

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PERSONAL DATA USE CONSENT

By submitting this form, you agree and consent to your personal data which you provide to KL FERTILITY CENTRE (“KLF”) in this form being processed, collected, used, disclosed and/or retained by KLF and its members, officers, employees, servants, agents, representatives and sub-contractors for (a) the purposes of administering the (a) Registration and in relation to your participation in the same, (b) promotional, marketing and publicity purposes relating to the Registration and KLF generally, (c) for KLF’s conduct of research, analysis and development activities (including data analytics, surveys and/or profiling) to enhance KLF’s programme offerings and operations, and (d) reference and archival purposes, in accordance with KLF's policies and processes relating to personal data protection.

For more information on KLF's Privacy Policy, please visit https://klfertility.com/privacy-policy/

Phone

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Schedule an appointment

+603 2780 4288

KL Fertility Centre
LG Lot 23A, 25, 26, 27 & 30 DC MALL,
No 6 Jalan Damanlela, Bukit Damansara,
50490 Kuala Lumpur, Malaysia.

TELEPHONE
+603 2780 4288

FAX
+603 2780 4299

Clinic Days
Mondays to Fridays: 8am to 5pm
Saturdays: 8am to 1pm
Sundays and Public Holidays: CLOSED

Patient's Particulars

Referring Doctor's Info

Do you have any specific question on IVF, ICSI or IUI?