FOR DOCTORS ONLY

Immunise4Life is a programme aimed to increase awareness about vaccine-preventable diseases and life-course immunisation. If you are currently offering vaccines for adult, children or both and would like to list your practice under our online clinic directory, kindly fill in the form below.

Should you have any questions, kindly contact the programme secretariat at mobile: +6012 284 1628, Mondays to Fridays from 10am to 6pm or email secretariat@immunise4life.my.

Thank you.

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* 1. Doctor's Name

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* 2. MMC Number

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* 3. Specialisation

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* 4. Sub-Specialisation

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* 5. Email

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* 6. Clinic Name

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* 7. Clinic Address

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* 8. State

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* 9. Clinic Tel. No.

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* 10. Do you offer vaccination to these groups below at your clinic?

For the Immunise4Life secretariat (Ultra Works Sdn Bhd) to list your clinic in the online directory, the secretariat will gather and process your personal information collected through this registration form. Concerned Individuals have a right of access to all information held about them. They also have the right to ask for this information to be rectified or deleted. Concerned Individuals who wish to exercise such rights should contact secretariat@immunise4life.my or call +6012 284 1628.

Untuk sekretariat Immunise4Life (Ultra Works Sdn Bhd) menyenarai klinik anda di direktori atas talian, sekretariat akan mengumpul dan memproses maklumat peribadi anda yang didapati di borang pendaftaran ini. Individu yang berkenaan mempunyai hak untuk mengakses semua maklumat peribadi mereka yang dipegang oleh Immunise4Life. Mereka juga berhak meminta maklumat tersebut diperbetulkan atau dihapuskan. Individu yang berkenaan yang berhasrat untuk menggunakan hak tersebut boleh menghubungi sekretariat Immunise4Life di secretariat@immunise4life.my atau hubungi +6012 284 1628.
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