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| info@specialists.hk | 3405 8288 |
Day Procedure Centre Licence: DP000305

Appointment of Specialist

Notice:

Thank you for your reservation request. Please note that is NOT a confirmed reservation. Our staff will confirm your consultation details by phone within ONE working day.
For any enquiries, you are welcome to contact our service hotline at 3405-8288.
The information provided by the applicant will be used for appointment only.

I. Services Specialist
Specialist
Doctor
II. Personal Info
Titles
Chinese Name
English Name
Day of Birth Year Month Day
ID card No
Mobile No
Email
III. Appointment details
Preferred Date:
Alternative Date
Other Info
A.
Relationship with the client (if the form is not filled in by the client)
B.
Please tick the reason(s) for booking (may choose more than one)
Services
1.
Child and Adolescent Mental Health
2.
Adult Mental Health
3.
Elderly Mental Health
4.
Mental Capacity Assessment (e.g. guardianship order assessment or assessment of mental capacity for Part II of the Mental Health Ordinance)
5.
Mental Report (Please state the nature and purpose of the medical report):
Please note that we provide non-urgent services only. For urgent requests or clients at immediate risk of harming themselves or others, please call 999 or visit the nearest Accident and Emergency Department for immediate assistance and assessment.
Validation