Referral Form

Schedule an appointment

Note: Please do not use this form to arrange appointments or request reports. Instead, kindly call the number above.

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Last Name*
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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://www.klfertility.com/privacy-policy/
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Patient's Particulars