Regency Specialist Hospital

Make an appointment

To make an appointment with Regency Specialist Hospital, please kindly fill up the form. For emergency events, please kindly proceed to our 24-hour Emergency Department.

* Patient’s Name	(as in Identity Card/ Passport)
* Patient’s IC/Passport No.
* Date of Birth
* Gender
* Marital Status
* Address
* Country
* Your Medical Condition
* Name (if contact person is different from above patient’s name)
* Email
* Telephone (Home)
* Telephone (Office)
* Handphone
Fax number
Preferred contact
Please call me at