Member Application Form – Hong Kong Health Check & Medical Diagnostic Group Limited

Personal Information

*Required

Name *

Gender *

Male
Female

Age

Age: 18

Date of Birth *

Occupation

Address *

Contact No. *

Email *

Pick Up Branch *

Other Information

1. Monthly Income:

$5,000 or less
$5,001-$10,000
$10,001-$15,000
$15,001 or above

2. How often do you do health check?

Others How often do you do health check? *

How do you know HKHC?

Newspaper
Website
Friend
Others

Other (How do you know HKHC?) *

Data collected will be used to keep you up-dated with Hong Kong Health Check information and membership check up offer. Please tick the box if you do not want to receive information from Hong Kong Health Check.

Data collected will be used to keep you up-dated with Hong Kong Health Check information and membership check up offer. Please tick the box if you do not want to receive information from Hong Kong Health Check.

Read and accept the Terms and Conditions. *

I have read and accept the Terms and Conditions. *

Disclaimer & Privacy Policy。