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Only applicable to existing patients whose last visit was within 3 months, subject to physician’s review.
The request form will be reviewed (subject to physician’s approval) and prepared during working hours (Mondays to Fridays, 9.00am to 6.00pm).
Payment can be made online via PayPal
Orders will be processed and delivered to your specified delivery address in Singapore within 3 working days upon confirmation of order transaction and fully receipt of payment.
Charges for medication are identical to in-clinic rates. Delivery charges apply.
Conditions apply. For more details, please refer to our Terms & Conditions.
By completing and submitting this form, I hereby declare and warrant that the personal data which I am providing to you in this form, is legitimate and accurate, that I am providing the personal data to Ma Kuang Chinese Medicine & Research Centre Pte Ltd (Whether directly or through third party service providers) to collect, use, disclose and process such personal data for the purpose of processing medication delivery service.
For data privacy, please refer to privacy policy.
Title:
Name:
NRIC/Passport No:
Date of Birth
Contact No：
Email Address
Postal code:
Delivery Address 1：
Delivery Address 2：
Floor:
Unit No:
Clinic Visited：
Date of Last Visit ：
Days of Repeat Medication Required：
Remark :
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