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Appointment Details
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Patient Details
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Patient Details
Appointment Details
Summary
Appointment Details
Next: Summary

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Patient Details
Appointment Details
Summary
Summary
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Please confirm your information below:

Patient Details
Salutation

Full name

IC number/Passport number

Email address

Date of birth

Country code

Contact number

Appointment Details
Hospital location

Preferred doctor

Date

Time

By providing the information set out in this form, I consent to Pantai Holdings Sdn Bhd (PANTAI) and their representatives and/or agents collecting, using and disclosing my personal data to provide me with medical treatment and other reasonably related purposes. Such purposes are set out in the PANTAI Data Privacy Policy, accessible at https://www.pantai.com.my/Privacy-Policy or available on request. I further confirm that all personal data that I have provided are all true, up-to-date and accurate. Should there be any changes to any of my personal data, I shall notify PANTAI immediately.

I understand that I may withdraw such consent at any time via unsubscribe facilities OR forms available on request from our staff OR by email to PANTAI CPO at my.mod.cpo@parkwaypantai.com

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Our customer service representative will contact you to confirm your appointment within the next working day.

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EMERGENCY CONTACT
Gleneagles Hospital Kota Kinabalu
Ambulance / Emergency
+6088 518 911