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Referral Form

  • Patient's Particulars

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    • Referring Doctor's Info

    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: +603 2780 4288.

    • 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/

    • This field is for validation purposes and should be left unchanged.
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    +603 2780 4288

    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 the number above.

    • 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/

    • This field is for validation purposes and should be left unchanged.
    KL Fertility Centre
    LG Lot 30, DC MALL,
    No 6 Jalan Damanlela, Bukit Damansara,
    50490 Kuala Lumpur, Malaysia.
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    +603 2780 4288

    FAX
    +603 2780 4299
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    KL Fertility Centre
    ENGLISH 中文简体 B. MALAYSIA
    2022 © KL Fertility Centre
    KKLIU 2426/2020
    COVID-19 & Fertility
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    Which One are You?
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    Meet The Practice
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    • Dato’ Dr. Prashant Nadkarni
    • Dr. Helena Lim Yun Hsuen
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    KL Fertility Centre
    LG Lot 30, DC MALL,
    No 6 Jalan Damanlela, Bukit Damansara,
    50490 Kuala Lumpur, Malaysia.
    TEL +603 2780 4288
    FAX +603 2780 4299
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    Our business hours:

    Mondays to Fridays: 9am to 4pm
    Saturdays: 9am to 1pm
    Sundays and public holidays: CLOSED

    Please note that our clinic follows the Malaysia calendar,
    therefore, please leave a message on our phone if you have called during non-working hours.
    Thank you.