Out-Patient Department Booking Request

Surname in English:* Specialty:*
Givenname in English:* Doctor:*
Name in Chinese
(if applicable):
First priority booking date:*
Email:* First priority booking timeslot:*
Mobile phone number:* Second priority booking date:
Second priority booking timeslot:
* = mandatory information
Thank you for using Out-Patient Department Booking Request service. Please note that the appointment application on this website is solely for scheduling purposes. Our staff will notify you of the appointment result via email or telephone. St. Teresa’s Hospital is not responsible for any consequences arising from the failure of online appointment booking.

Your personal data will be kept confidential and used solely for the purpose of appointment scheduling, and it will not be retained longer than necessary to fulfill that purpose. Without your consent, we will not disclose your information to any third party, except as required by law.
I have read and understood this statement, all information provided by me is true and accurate.