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)
INTERNATIONAL BLOOD TEST
Pakej A \| Basic Bloodtest I I Pre Diabetes I DPS3C + ESR I
Pakej B \| Advance Bloodtest II I Thyroid I DPM3C, TSH, T3, & T4 I
Pakej C \| Advance Bloodtest III-A I Tumor/Cancer I DPB3C, CEA, CA125, CA19-9, CA15-3 I WOMEN ONLY
Pakej C-2 \| Advance Bloodtest III-B I Tumor/Cancer I DPB3C, CEA, CA19-9, CA15-3 & PSA I MEN ONLY
Pakej D \| Advance Bloodtest IV I Cardiac Screen 1/Diabetes(Gold) I DPT3C & CAR I
Pakej E \| Advance Bloodtest V I Cardiac Screen 2 / Diabetes 2 (Platium) I DPT3C, CAR, HS-CRP, HOMOCYSTEINE I
General Screening Add-On - Type A \| Tumor/Cancer Marker \| AFP
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CEA
General Screening Add-On - Type A \| Tumor/Cancer Marker \| PSA
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA19-9
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA125
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA15-3
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CRP
General Screening Add-On - Type A \| Tumor/Cancer Marker \| UAC/MAS(MACROALBUMIN)
Extensive 107 Allergy Test \| RM416
Domestic Allergy Panel(includes total IgE) \| DAP \| RM290
Food Intolerance Test \| FIT \| RM2900
Seafood Allergy Panel(includes total IgE) \| SAP \| RM350
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
Cardiac Screen 1 \| CART \| RM150
Cardiac Screen 2 \| CRF2A \| RM250
Cardiovascular Risk & Stroke Assessment \| CARD0 \| RM880
Coronary Risk Factors 2 \| CRF02 \| RM290
Male Hormone Studies \| TSB \| RM180
Pituitary Studies \| PIT \| RM320
Thyroid Function \| TFT \| RM90
Coeliac Disease Screen \| COELIAC \| RM1400
Multiple Myeloma Profile \| MMF \| RM750
Cancer Markers (Female) \| FCM \| RM280
Cancer Markers (Male) \| MCM \| RM180
Lung Cancer Marker \| QCM \| RM880
Arthritis Profile 1 \| ARTH1 \| RM390
Arthritis Profile 2 \| ARTH2 \| RM190
Lupus Full Assessment \| V2 \| RM390
Endocrinology Add-On \| Ghrelin \| REF \| RM690
Endocrinology Add-On \| Glucagon \| GCG \| RM690
Endocrinology Add-On \| Growth Hormone \| GH \| RM190
Endocrinology Add-On \| Insulin Level \| INS \| RM150
Endocrinology Add-On \| Insulin Pro \| REF \| RM490
Endocrinology Add-On \| Serotonin \| SRT REF \| RM790
Immunology Add-On \| G6PD - Qualitative \| GPD \| RM20
Immunology Add-On \| G6PD - Quantitative \| GPQ \| RM110
Cancer/Oncology Add-On \| Beta-2-Microglobulin \| BMG \| RM110
Cancer/Oncology Add-On \| NPC Screen (EBV VCA IgA) \| VCA \| RM150
Anti-Mullerian Hormone
Vitamin D
JUMLAH


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

BUTIRAN PELANGGAN

Nama

Emel

Sahkan Emel

Nombor HP

Alamat

Poskod

Bandar

Negeri

Negara

Penama	LA Wellness Sdn Bhd
No. Akaun	553038617187

Maklumat Peniaga

	LA Wellness Sdn Bhd
	support@liyanatan.com
	+60125919063

Produk	Kuantiti	Harga (RM)
INTERNATIONAL BLOOD TEST
Pakej A \| Basic Bloodtest I I Pre Diabetes I DPS3C + ESR I
Pakej B \| Advance Bloodtest II I Thyroid I DPM3C, TSH, T3, & T4 I
Pakej C \| Advance Bloodtest III-A I Tumor/Cancer I DPB3C, CEA, CA125, CA19-9, CA15-3 I WOMEN ONLY
Pakej C-2 \| Advance Bloodtest III-B I Tumor/Cancer I DPB3C, CEA, CA19-9, CA15-3 & PSA I MEN ONLY
Pakej D \| Advance Bloodtest IV I Cardiac Screen 1/Diabetes(Gold) I DPT3C & CAR I
Pakej E \| Advance Bloodtest V I Cardiac Screen 2 / Diabetes 2 (Platium) I DPT3C, CAR, HS-CRP, HOMOCYSTEINE I
General Screening Add-On - Type A \| Tumor/Cancer Marker \| AFP
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CEA
General Screening Add-On - Type A \| Tumor/Cancer Marker \| PSA
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA19-9
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA125
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CA15-3
General Screening Add-On - Type A \| Tumor/Cancer Marker \| CRP
General Screening Add-On - Type A \| Tumor/Cancer Marker \| UAC/MAS(MACROALBUMIN)
Extensive 107 Allergy Test \| RM416
Domestic Allergy Panel(includes total IgE) \| DAP \| RM290
Food Intolerance Test \| FIT \| RM2900
Seafood Allergy Panel(includes total IgE) \| SAP \| RM350
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
Cardiac Screen 1 \| CART \| RM150
Cardiac Screen 2 \| CRF2A \| RM250
Cardiovascular Risk & Stroke Assessment \| CARD0 \| RM880
Coronary Risk Factors 2 \| CRF02 \| RM290
Male Hormone Studies \| TSB \| RM180
Pituitary Studies \| PIT \| RM320
Thyroid Function \| TFT \| RM90
Coeliac Disease Screen \| COELIAC \| RM1400
Multiple Myeloma Profile \| MMF \| RM750
Cancer Markers (Female) \| FCM \| RM280
Cancer Markers (Male) \| MCM \| RM180
Lung Cancer Marker \| QCM \| RM880
Arthritis Profile 1 \| ARTH1 \| RM390
Arthritis Profile 2 \| ARTH2 \| RM190
Lupus Full Assessment \| V2 \| RM390
Endocrinology Add-On \| Ghrelin \| REF \| RM690
Endocrinology Add-On \| Glucagon \| GCG \| RM690
Endocrinology Add-On \| Growth Hormone \| GH \| RM190
Endocrinology Add-On \| Insulin Level \| INS \| RM150
Endocrinology Add-On \| Insulin Pro \| REF \| RM490
Endocrinology Add-On \| Serotonin \| SRT REF \| RM790
Immunology Add-On \| G6PD - Qualitative \| GPD \| RM20
Immunology Add-On \| G6PD - Quantitative \| GPQ \| RM110
Cancer/Oncology Add-On \| Beta-2-Microglobulin \| BMG \| RM110
Cancer/Oncology Add-On \| NPC Screen (EBV VCA IgA) \| VCA \| RM150
Anti-Mullerian Hormone
Vitamin D
JUMLAH

PAKEJ SARINGAN DARAH

BUTIRAN PEMBELIAN

BUTIRAN PELANGGAN

PENGESAHAN

INVOIS

BUTIRAN PEMBAYARAN

PENGESAHAN