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Endoscopists
Registration Form
Registration Type:
Endoscopists
Non-Endoscopists
Doctor Name*
Chinese Name
Endoscopy Privilege to any private hospital in Hong Kong
OGD
Colonoscopy
Cystoscopy
ESD
EUS
Capsule Endoscopy
Which Hospitals?
Certificate provided
A.P.C
M.P.S
Specialty
Use company name on bill?
Yes
No
Company Name
Business Registration Number: (if any)
Clinic Address*
Tel No
Fax No
Email*
Emergency contact mobile No.*
Contact person for billing matters *
Tel No (Contact person for billing matters) *
Billing or A/C Dept. address (if different to clinic address)
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50001
mksacr771601