PAKEJ SARINGAN DARAH

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Sila isi butiran bawah bagi memudahkan Appointment Ujian Darah

Sila pilih Tarikh Appointment dan pilih tempat ujian darah pada senarai Innoquest Lab yang diberi oleh coach anda.

Anda Di hendaki BERPUASA SELAMA 12 JAM sebelum Hadir ke Makmal untuk mengambil darah.

Nama:

No. I/C:

Lokasi Lab Innoquest:

Tarikh Appointment:

Sila Lampiran pic lesen/ic untuk pengesahan ejaan dan no ic anda bg elakkan kesilapan pada pendaftaran ujian darah

Pihak kami akan membuat appointment untuk pihak anda & anda perlu hadir pada hari tersebut dengan memberikan i/c di kaunter

Jika ada soalan, Sila Taipkan Soalan Anda

Sila reply segera, untuk membolehkan pihak kami fokus anda hingga sembuh secepat mungkin.

Perhatian! Sila lengkapkan borang di bawah.

Ruangan yang wajib diisi

BUTIRAN PEMBELIAN

Produk	Kuantiti	Harga (RM)
Pakej A \| Basic Bloodtest I I Pre Diabetes I IQMY1 + ESR I
Pakej B \|Wellness Screening\| Thyroid I IQMY1, ESR, TSH, T3, & T4 I
Pakej C-1\| Women Cancer Screening I IQMY1, ESR, CEA, CA125, CA19-9, CA15-3 I
Pakej C-2 \| Men Cancer Screening I IQMY1, ESR,CEA, CA19-9, CA15-3 & PSA I
Pakej D \| Cardiac Health Screening (Gold) I IQMY1, ESR & CAR I
Pakej E \| Premium Full Body Health screening I IQMY1, ESR, CART, HS-CRP, HOMOCYSTEINE I
INTERNATIONAL BLOOD TEST
BLOODGROUP\|RM25
ANE\| ANAEMIA STUDIES\|RM 198
Anti-Mullerian Hormone\| AMH\|RM 380
Cancer/Oncology Add-On \| Beta-2-Microglobulin \| BMG \| RM146
Cancer/Oncology Add-On \| NPC Screen (EBV VCA IgA) \| VCA \| RM180
General Screening Add-On - Type A \| Tumor/Cancer Marker \| AFP\|RM56
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CEA\|RM 64
General Screening Add-On - Type A \| Tumor/Cancer Marker \| PSA\|RM80
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA19-9\|CA9\|RM94
General Screening Add-On - Type A \| Tumor/Cancer Marker \| \|CA125\|CA1\|RM94
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA15-3\|CA5\|RM94
General Screening Add-On - hs-CRP\|CRP\|\|RM68
Endocrinology Add-On \| Ghrelin \| REF \| RM760
Endocrinology Add-On \| Glucagon \| GCG \| RM800
Endocrinology Add-On \| Growth Hormone \| GH \| RM280
Endocrinology Add-On \| Insulin Level \| INS \| RM176
Endocrinology Add-On \| Insulin Pro \| REF \| RM580
Endocrinology Add-On \| Serotonin \| SRT REF \| RM880
Hepatitis \| Hep Bs Antibody(HBsAb)\|Hep Bs Antigen\|HB1\|HB2\|RM 50
MICRONUTRIENTS \| Vitamin D \| OHD\|RM160
Domestic Allergy Panel(includes total IgE) \| DAP \| RM330
Food Intolerance Test \| FIT \| RM3300
Anti-Ageing Ladies SAAPF Profile(NORMAL) \| SAAPF \| RM850
Anti-Ageing Men SAAPM Profile(NORMAL) \| SAAPM \| RM750
Aurelia Anti-Ageing Screen (Female) (PREMIUM) \| P.AU-RAAF \| RM1200
Aurelia Anti-Ageing Screen (Male) (PREMIUM) \| P.AU-RAAM \| RM1200
Lupus Full Assessment \| V2 \| RM450
Arthritis Profile 1 \| ARTH1 \| RM440
Arthritis Profile 2 \| ARTH2 \| RM240
Immunology Add-On \| G6PD - Qualitative \| GPD \| RM24
Immunology Add-On \| G6PD - Quantitative \| GPQ \| RM140
Coeliac Disease Screen \| COELIAC \| RM1700
Multiple Myeloma Profile \| MMF \| RM900
Cardiac Screen 1 \| CART \| RM180
Cardiac Screen 2 \| CRF2A \| RM280
Cardiovascular Risk & Stroke Assessment \| CARD0 \| RM1020
Male Hormone Studies \| TSB \| RM200
Pituitary Studies \| PIT \| RM380
Thyroid Function \| TFT\|FT4\|FT3 \| RM110
HOMOCYCSTEINE FASTING I HOC \|RM 130
OESTRADIOL\|E2\|FEMALE\|RM72
OESTRADIOL\|E2\|MALE\|RM72
TES\|TESTOSTERONE TOTAL\|RM 80
FTE\|TESTOSTERONE FREE\|RM520
JUMLAH


Kupon Diskaun Masukkan kod kupon di bawah (jika ada) dan tuntut!
JUMLAH KESELURUHAN (RM)
Caj Perkhidmatan Peniaga (RM)

BUTIRAN PELANGGAN

Nama

Emel

Nombor HP

Alamat

Poskod

Bandar

Negeri

Negara

Nota Tambahan

Produk	Kuantiti	Harga (RM)
Pakej A \| Basic Bloodtest I I Pre Diabetes I IQMY1 + ESR I
Pakej B \|Wellness Screening\| Thyroid I IQMY1, ESR, TSH, T3, & T4 I
Pakej C-1\| Women Cancer Screening I IQMY1, ESR, CEA, CA125, CA19-9, CA15-3 I
Pakej C-2 \| Men Cancer Screening I IQMY1, ESR,CEA, CA19-9, CA15-3 & PSA I
Pakej D \| Cardiac Health Screening (Gold) I IQMY1, ESR & CAR I
Pakej E \| Premium Full Body Health screening I IQMY1, ESR, CART, HS-CRP, HOMOCYSTEINE I
INTERNATIONAL BLOOD TEST
BLOODGROUP\|RM25
ANE\| ANAEMIA STUDIES\|RM 198
Anti-Mullerian Hormone\| AMH\|RM 380
Cancer/Oncology Add-On \| Beta-2-Microglobulin \| BMG \| RM146
Cancer/Oncology Add-On \| NPC Screen (EBV VCA IgA) \| VCA \| RM180
General Screening Add-On - Type A \| Tumor/Cancer Marker \| AFP\|RM56
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CEA\|RM 64
General Screening Add-On - Type A \| Tumor/Cancer Marker \| PSA\|RM80
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA19-9\|CA9\|RM94
General Screening Add-On - Type A \| Tumor/Cancer Marker \| \|CA125\|CA1\|RM94
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA15-3\|CA5\|RM94
General Screening Add-On - hs-CRP\|CRP\|\|RM68
Endocrinology Add-On \| Ghrelin \| REF \| RM760
Endocrinology Add-On \| Glucagon \| GCG \| RM800
Endocrinology Add-On \| Growth Hormone \| GH \| RM280
Endocrinology Add-On \| Insulin Level \| INS \| RM176
Endocrinology Add-On \| Insulin Pro \| REF \| RM580
Endocrinology Add-On \| Serotonin \| SRT REF \| RM880
Hepatitis \| Hep Bs Antibody(HBsAb)\|Hep Bs Antigen\|HB1\|HB2\|RM 50
MICRONUTRIENTS \| Vitamin D \| OHD\|RM160
Domestic Allergy Panel(includes total IgE) \| DAP \| RM330
Food Intolerance Test \| FIT \| RM3300
Anti-Ageing Ladies SAAPF Profile(NORMAL) \| SAAPF \| RM850
Anti-Ageing Men SAAPM Profile(NORMAL) \| SAAPM \| RM750
Aurelia Anti-Ageing Screen (Female) (PREMIUM) \| P.AU-RAAF \| RM1200
Aurelia Anti-Ageing Screen (Male) (PREMIUM) \| P.AU-RAAM \| RM1200
Lupus Full Assessment \| V2 \| RM450
Arthritis Profile 1 \| ARTH1 \| RM440
Arthritis Profile 2 \| ARTH2 \| RM240
Immunology Add-On \| G6PD - Qualitative \| GPD \| RM24
Immunology Add-On \| G6PD - Quantitative \| GPQ \| RM140
Coeliac Disease Screen \| COELIAC \| RM1700
Multiple Myeloma Profile \| MMF \| RM900
Cardiac Screen 1 \| CART \| RM180
Cardiac Screen 2 \| CRF2A \| RM280
Cardiovascular Risk & Stroke Assessment \| CARD0 \| RM1020
Male Hormone Studies \| TSB \| RM200
Pituitary Studies \| PIT \| RM380
Thyroid Function \| TFT\|FT4\|FT3 \| RM110
HOMOCYCSTEINE FASTING I HOC \|RM 130
OESTRADIOL\|E2\|FEMALE\|RM72
OESTRADIOL\|E2\|MALE\|RM72
TES\|TESTOSTERONE TOTAL\|RM 80
FTE\|TESTOSTERONE FREE\|RM520
JUMLAH

Penama	AURALIYANA HEALTH & BEAUTY SDN BHD
No. Akaun	31001096627

Penama	AURALIYANA HEALTH & BEAUTY SDN BHD
No. Akaun	31001096627

BUTIRAN PEMBELIAN

BUTIRAN PELANGGAN

INVOIS

BUTIRAN PEMBAYARAN