Health screening registration for Employees

Full Name as per NRIC/Work Pass*

NRIC/FIN

Mobile Number*

Email

Date of Birth*

Company*

Screening Location: Madame Tussauds HQ
40 Imbiah Rd, Sentosa, 099700

Pay on Site: Cash, Credit Card and Pay Now

Special Pricing for Madame Tussauds' Employees
Click here to view the Preferential Rates for you!

Choose your Health Screening Package (Fasting Required)*

Screening Date*

Preferred Health Screening Time (Subject to availability, alternatives will be provided if selected timing is unavailable)*

Additional Services to sign up for
RETINA SCREENING - S$80 (Conducted at SJ)
cPass - S$56
ULTRASOUND HEPATOBILIARY SYSTEM (pancreas, liver, gallbladder, spleen and bile duct)- $192.60
ULTRASOUND ABDOMEN (INCLUDING liver, gallbladder, spleen, pancreas, and kidneys- $251.45
ULTRASOUND KIDNEYS- $128.40
ULTRASOUND THYROID - $139.10
ULTRASOUND PELVIS (TRANSABDOMINAL) - $149.80
ULTRASOUND PELVIS (TRANSVAGINAL)) - $192.60
ULTRASOUND PROSTATE - $149.80
ULTRASOUND BREAST- $139.10
ULTRASOUND KUB (KIDNEYS & BLADDER) - $192.60
MAMMOGRAM - $197.95
MAMMOGRAM & ULTRASOUND BREAST - $256.80
BONE MINERAL DENSITY (DEXA) - $132.70

As part of the health screening procedure and to ease waiting time on screening day, we seek your help in providing the below information.

Race - arrange in alphabetical order*
Chinese
Eurasian
Indian
Malay

Gender*
Male
Female

Do you smoke?*
Yes
No

Do you drink Alcohol?*
Yes
No

if Yes, how often do you drink? An alcoholic drink is defined as a can (330 ml) of regular beer, half a glass (100 ml) of wine or 1 nip (30 ml) of spirit.

How often you exercise per week?*
I lead a sedentary lifestyle
Once a week
2-3 times a week
More than 3 times weekly

Have you had health screening before?*
Yes
No

If Yes, when was the last screening

Do you have any Dietary restrictions or plans?*
Yes
No

If Yes, Please elaborate

Are you on regular medication?*
Yes
No

If Yes, Please elaborate

Are you on regular supplements?*
Yes
No

If Yes, Please elaborate

Do you have a history of any of the following?*
Diabetes
High Blood Pressure
Gastrointestinal conditions
High Cholesterol
Heart Diseases eg: Stroke or heart attacks
Cancer
Asthma
None
Others

Please Elaborate if you have any history of the above:

Does your family have a history of any of the following?*
Diabetes
High Blood Pressure
Gastrointestinal conditions
High Cholesterol
Heart Diseases eg: Stroke or heart attacks
Cancer
Asthma
None
Others

Please Elaborate if you have any history of the above:

Please Elaborate if you had surgical history:

Consent*
I agree to be contacted by 7 Vision
I hereby authorise, agree and consent to allow 7 Vision Pte. Ltd. to:
a. collect, use, disclose and/or process personal data about me that I had provided 7 Vision Pte Ltd, that I now provide 7 Vision Pte Ltd, that I may in future provide 7 Vision Pte Ltd with and/or that 7 Vision Pte Ltd possesses about me including but not limited to my name, my date of birth, my identification number, my email address, my telephone numbers, my address for the following purposes:
• facilitating, processing, dealing with, administering, managing and/or maintaining our relationship with 7 Vision Pte Ltd;
• storing, hosting, backing up (whether for disaster recovery or otherwise) of my personal data, whether within or outside Singapore,
(collectively the “Purposes”);
b. disclose personal data about me to 7 Vision Pte Ltd third party service providers and agents (“Representatives”) that are engaged by 7 Vision Pte Ltd to perform certain functions in connection with the Purposes, so long as disclosure is necessary to enable such Representatives to perform the said functions. The Representatives may be located within or outside Singapore. In this regard, I hereby acknowledge, agree and consent that the said Representatives may, to the extent necessary to perform the said functions, collect, use, disclose and/or process my personal data.
Should you wish to withdraw your consent in part or whole, please send an email to our Data Protection Officer at [email protected] and provide details of your withdrawal. If you have any questions relating to our collection, use and disclosure of your personal data or the matters set out in this agreement, you may contact our Data Protection Officer.

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