Referral Form - KL Fertility Centre

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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.

First Name*
Last Name*
Email*
Telephone*
Message*
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PERSONAL DATA USE CONSENT*
- Please tick if you agree to proceed.
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.local/privacy-policy/
Phone
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KL Fertility Centre
LG Lot 30, DC MALL,
No 6 Jalan Damanlela, Bukit Damansara,
50490 Kuala Lumpur, Malaysia.

TELEPHONE
+603 2780 4288

FAX
+603 2780 4299

Clinic Days
Monday - Saturday
(except Sunday and Public Holidays)