Medical Form Singapore PDF Details

Medical Form Singapore is an online resource for individuals and families looking for information on medical procedures and healthcare in Singapore. Our mission is to provide accurate, up-to-date information on the latest medical treatments available in Singapore. Whether you are considering a medical procedure or just want to learn more about the healthcare system in Singapore, our website has everything you need.

Listed here, you'll see some specifics about medical form singapore PDF. You may go through it just before typing in the form.

Form NameMedical Form Singapore
Form Length4 pages
Fillable fields116
Avg. time to fill out24 min 16 sec
Other namesMedical Report Form SP Medical Report Form - Singapore Polytechnic

Form Preview Example


Medical Report Form

Admission Number

(This medical report will not be returned to the student)

This form may take you 3 minutes to ill. The data provided will be kept strictly conidential and used for the purpose of assessing itness for admission to a course.

Students with the following medical conditions should not pursue the respective courses stipulated.

If you are suffering from colour vision deiciency, you should not pursue the following courses:


Applied Chemistry with


Chemical Engineering

- Food Science & Technology


Pharmaceutical Science

- Electrical & Electronic Engineering


Marine Engineering


Biomedical Science


Engineering Systems


Nautical Studies @







@Student must pass the Maritime and Port Authority of Singapore Sight Test.

If you are suffering from either colour vision deiciency or hearing loss (partial or complete), you should not pursue the following courses:

- Aeronautical Engineering

- Aerospace Electronics

- Energy Systems and Management

If you are suffering from or have a history of epilepsy, you should not pursue an Engineering course.

For the Computer Engineering course, if you are suffering from impairments, you must be prepared to appear for interviews and to undergo any manual dexterity or aptitude tests.

For the Visual Effects and Motion Graphics course, if you are suffering from colour vision deiciency, you will be required to attend an interview to determine your suitability for admission to the course.

Students with Autism / Asperger Syndrome may be referred to a psychiatrist to help them to prepare for a new learning environment.


APersonal Particulars








NRIC / Foreign Identiication:


Date of Birth:














Gender: Male / Female

B Medical Information


1. Family Doctor / Clinic:


2.Do you have or have you ever had any of the following conditions? Please indicate by checking ( ) the appropriate column. If your answer is 'Yes', give details (#) below and attach medical report (if necessary):










Active Tuberculosis



Autism / Asperger Syndrome



Hearing Loss






Colour Vision Deiciency



HIV Positive / AIDS












Attention Deicit Hyperactivity






Psychiatric Condition



Disorder (ADHD / ADD)






Vision Loss (excluding myopia)



Other Medical Conditions:



Other Physical Disability:



(#) Details:

3.Please provide your Family, Social and Drug history by checking below. If your answer is 'Yes', give details.




i)Family History

Diabetes Hypertension Heart Disease Psychiatric Condition Stroke Tuberculosis

ii)Social History


Number of sticks per day :

(Smoking is a disciplinary offence on campus.)




iii)Drug History

Drugs taken presently


I hereby declare that all the information provided is true and accurate to the best of my knowledge and I have not deliberately omitted any relevant fact. I agree to a medical practitioner completing the form overleaf for submission to SP on my behalf.

Student's Signature:



Name :


Admission No :


Course :



Height (m) :





Weight in kg


Urine Analysis:






































Weight (kg) :






(Height in m)2

















If BMI > = 23 (moderate -































high risk)







































Acuity of Vision









Colour Vision (tick one only)


















Ishihara Test




















Without glasses
































With glasses










Partial: Red / Green deiciency







































History of Epilepsy:



















If yes,









Complete: Red / Green deiciency









Still on Medication







































Chest X-Ray Report:





















































Eyes :









Blood Pressure :






Ears :









Pulse :






Nose :









Heart :






Teeth :









Abdomen & Pelvis :






Gums :









Hernia (Enlarged Rings) :






Tonsils :









Skin :






Back / Spine :









Mental Disposition :






Injury, Operation, Illness:














Referrals (All fees are to be borne by the student.)

-Those with or suspected to have psychiatric condition must be referred to a psychiatrist for further assessment.

-Those with epilepsy must be referred to a Designated Workplace Doctor who will assess their itness for courses.

Blood Test (May be required at the discretion of the Medical Practitioner. All fees are to be borne by the student.) Test Result :

Certiication of Fitness

1.I have today completed a medical examination of the person named overleaf and ind this student for admission to be free / not free* from organic and infectious diseases.

2.The student is physically and mentally

Fit / Unit* to pursue the course indicated.

Fit / Unit* to pursue Any Other Course / Other Courses*

Remarks (if any) :

* Please delete accordingly. The student is deemed unit unless certiied it.

To be completed by the Medical Practitioner if the student is enrolling for the Diploma in Marine Engineering / Nautical Studies Course only

Diploma in Marine Engineering Course

The student is it / unit* to be employed on board ship as Cadet Engineer / Engineer Oficer.

Diploma in Nautical Studies Course

The student is it / unit* to be employed on board ship as a Cadet Deck Oficer.

Name of Registered Medical Practitioner:







(Signature of Doctor)




Name and Address of Practice:









Medical Check-Up and X-Ray for Full-Time Courses

Successful Applicants of all Full-Time courses are required to undergo a medical check-up and X-ray.

Bring along your SP Medical Report Form to the clinic. You may go to your own family doctor, private or company clinics for the medical check-up. Should you choose this option, please submit your medical report personally at Student Service Centre (Blk T16 Level

1)or mail in to Admissions Ofice, Singapore Polytechnic, 500 Dover Road, Singapore 139651 as soon as you have received it from your doctor.

Alternatively, you may go to any one of the clinics listed. Those who go for their medical check-up at the clinics listed will have their SP Medical Report dispatched to us by the clinics.

All full-time international students are required by the Immigration & Checkpoints Authority (ICA) to undergo a medical check-up with HIV testing. Please have both the SP and ICA Medical Examination Report Forms when you go to the clinic for your medical check-up. You will have to collect the ICA medical report from the clinic when it is ready.

Students will bear all medical charges including any referrals to Designated Workplace Doctors or other Specialists.

If the doctor has recommended you to undergo a blood test, the cost of this blood test is additional. Initial blood test is estimated at S$20.00.

Please inform the Admissions Ofice immediately should you have a medical condition that prohibits you from pursuing the offered course (e.g. colour vision deiciency). SP will need to arrange for a course transfer.

Call 6772-1882 or email with Subject Title: Medical Condition and provide your Name, Admission Number and Course Offered.


Opening Hours



SATA CommHealth

You may wish to avoid the peak periods: weekday mornings and Saturdays as waiting times can be stretched. Rate:

• Singaporean / Permanent Resident: S$30.00 (inclusive of 7% GST)

• International Student: S$49.00 (inclusive of 7% GST)

SATA Uttamram Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

351 Chai Chee Street


Singapore 468982


Tel: 6244-6688

8.30 am to 1.00 pm

MRT Station: Bedok

Weekend Surcharge: S$8.00

Bus Service:


222 (from Bedok MRT Station, in front of Blk 27, New Upper Changi Road)

Closed on Sundays & Public Holidays



SATA Jurong Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

Blk 135 Jurong Gateway Road




Singapore 600135

8.30 am to 1.00 pm

Tel: 6244-6688

Weekend Surcharge: S$8.00

MRT Station: Jurong East


Bus Service:

Closed on Sundays & Public Holidays

51, 66, 78, 79, 97, 98, 105, 197, 331




SATA Woodlands Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

900 South Woodlands Drive


#04-01 Woodlands Civic Centre


Singapore 730900

8.30 am to 1.00 pm

Tel: 6244-6688

Weekend Surcharge: S$8.00

MRT Station: Woodlands


Bus Interchange:

Closed on Sundays & Public Holidays

161, 168, 169, 178, 187, 856, 858, 900, 900A, 901, 902, 903, 911, 912, 913, 925,


926, 950, 960, 961, 962, 963, 963E, 964, 965, 966, 967, 968, 969, 970, 971




SATA Ang Mo Kio Medical Centre

Monday To Friday

(One-Stop Centre with X-Ray Services)

8.30 am to 5.00 pm

Blk 715 Ang Mo Kio Avenue 6

Evening Clinic

#01-4008 / 4010

Singapore 560715

6.00 pm to 9.00 pm

Tel: 6244-6688

Surcharge: S$5.00

MRT Station: Ang Mo Kio


Bus Interchange:


13, 86, 138, 162, 851, 852, 853

8.30 am to 1.00 pm


Weekend Surcharge: S$8.00


Closed on Sundays & Public Holidays



Singaporean / Permanent Resident: S$28.00 (inclusive of 7% GST)


International Student: S$47.50 (inclusive of 7% GST)




Ang Mo Kio – Thye Hua Kwan Hospital

Monday To Thursday

17 Ang Mo Kio Avenue 9

8.45 am to 3.30 pm

Singapore 569766

Lunch (Closed):12.00 noon to 2.00 pm

Tel: 6454-8481


MRT Station: Yio Chu Kang

Friday and Saturday

Bus Service:

8.45 am to 12.00 noon

76, 265, 268



Closed on Sundays & Public Holidays


Last appointment for AM session is at 11am


Last appointment for PM session is at 3 pm



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Medical Form Singapore StudentsSignature, and Date blanks to fill out

Identify the rights and obligations of the sides in the space Name, Admission, No Course, BMI, Weight, in, kg, Height, in, m If, BMI, moderate high, risk Urine, Analysis Glucose, Protein, Blood, Colour, Vision, tick, one, only, Ishihara, Test Normal, Partial, Red, Green, de, ici, en, cy and Complete, Red, Green, de, ici, en, cy

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