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Booking Request: Jockey Club “FertiWell” Programme

Please complete the form below

* Mandatory Fields

Jockey Club “FertiWell” Programme - Subfertility Service
HK$ 0
* Please select Venue
* Please select Venue
* Please select Meeting Time
Available time on
* Please select Appointment Time
Available Date
Selected Date

Before filling the form below, please select the date and time first!
* Please input Last Name
same as Hong Kong Identity Card
* Please input First Name
same as Hong Kong Identity Card
* Please select Gender
* Please input Hong Kong Contact Tel. No.
* Please input a valid Hong Kong Contact Tel. No.
Please provide an accurate phone number and ensure the phone number can receive phone calls
* Please input Email Address
* Please input a valid Email Address
Please provide an accurate email address and ensure the email account can receive emails
* Please select
* Please input The issuance date / validity date or period on the government assistance document
* Please select No. of Eligible Applicants
Remark 1: All eligible applicant or self-paid participant must enter all personal information and the issuance date / validity date or period on the government assistance document (if applicable)
Remark 2: For eligible individual applicant, please enter your personal information in Part A
Remark 3: If only one party of a couple is an eligible applicant, the other party has to pay the regular service fee

Part A: Main Applicant

* Please input Last Name
same as Hong Kong Identity Card
* Please input First Name
same as Hong Kong Identity Card
* Please select Gender
Please provide an accurate phone number and ensure the phone number can receive phone calls
* Please input Hong Kong Contact Tel. No.
* Please input a valid Hong Kong Contact Tel. No.
* Please input Hong Kong Contact Tel. No.(Night)
* Please input a valid Hong Kong Contact Tel. No.(Night)
Please provide an accurate email address and ensure the email account can receive emails
* Please input Email Address
* Please input a valid Email Address
* Please select
* Please input The issuance date / validity date or period on the government assistance document
* Please input Fax Number
* Please input a valid Fax Number

Part B: Applicant 2

* Please input Last Name
same as Hong Kong Identity Card
* Please input First Name
same as Hong Kong Identity Card
* Please select Gender
Please provide an accurate phone number and ensure the phone number can receive phone calls
* Please input Hong Kong Contact Tel. No.
* Please input a valid Hong Kong Contact Tel. No.
* Please input Hong Kong Contact Tel. No.(Night)
* Please input a valid Hong Kong Contact Tel. No.(Night)
Please provide an accurate email address and ensure the email account can receive emails
* Please input Email Address
* Please input a valid Email Address
* Please select
* Please input The issuance date / validity date or period on the government assistance document
* Please input Fax Number
* Please input a valid Fax Number
* Please input Year
* Please input Length
month(s)
* Please select Marital Status

Terms & Conditions 

  • Applicants are required to pay for additional services that are not covered by this Programme.
  • For PREPARE Couple Relationship Assessment & Pre-Marriage Preparation Group:
    • Both parties can use this service for free if at least one partner of each couple or a core family member residing with him/her is currently receiving or has received any of the above forms of government assistance (a) to (e) in the six months prior to the submission of application.
    • After submitting the online application, the Youth Health Care Centre will call the main applicant to schedule an appointment. The main applicant is required to attend one of the Youth Health Care Centres at the scheduled time and bring (i) his/her original of Hong Kong Identity Card, a photocopy of the other party’s Hong Kong Identity Card, and other documents to complete the registration, including (ii) valid original document to prove he/she is receiving or has received any of the above forms of government assistance (a) to (e) in the six months prior to the submission of application, or (iii) provide original of their Hong Kong residential address proof (for applicant residing with a core family member who is currently receiving or has received any of the above forms of government assistance (a) to (e) in the six months prior to the submission of application).
    • Applicants must attend two Group Sessions on time, there are no make-up classes for the Group Sessions. On the day of Group Session, if Tropical Cyclone Warning Signal No. 8 or above or the Black Rainstorm Signal is lowered 3 hours before the Group Session (i.e. before 6:30am on Saturday), the Group Session will be held as usual. Arrangements for make-up classes will be notified further.
    • Applicants must attend Individual Couple Follow-up Counselling Session on time and must notify the Youth Health Care Centre at least three working days in advance for rescheduling if they are unable to attend the Session, otherwise, the Session will be forfeited.
    • As to ensure service continuity, the whole service package must be completed within four months once the applicants receive this service; late arrangements will not be considered.
  • For Pre-marital Check-up / Pre-pregnancy Check-up, if only one party of a couple is an eligible applicant, the other party has to pay the regular service fee.
  • Please arrive at the designated service locations on time, submission of a new application may be required if the applicant is late or absent.
  • Applicants must complete the whole process of the service within the designated time.
  • Subject to the operation of the FPAHK clinics / Youth Health Care Centres, the booking arrangements may be adjusted to achieve a more effective use of the appointment slots and to streamline the operation of the FPAHK clinics / Youth Health Care Centres.
  • This Programme is subject to the latest information on the FPAHK website and it is subject to change without prior notice.

The Collection and Use of Personal Data Statement

The provision of personal data is voluntary and it will be used by The Family Planning Association of Hong Kong (FPAHK) for communication, handling applications and enquiries, providing service and other follow-ups. Apart from the above usage, all personal data will be kept confidential, handled strictly in accordance with applicable laws. Unless permitted or required by law, all personal data will not be disclosed or transferred to any third parties without your prior consent. FPAHK will only retain personal information for so long as it is necessary for the fulfillment of the purpose (including any directly related purpose) for which the data is collected. When the personal information that we collect is no longer required, we will destroy or delete it in a secure manner. You have a right of access and correction with respect to your personal data as provided for in sections 18 and 22 and Principle 6 of Schedule 1 of the Personal Data (Privacy) Ordinance. If you wish to access and correct your personal data, please contact us through email at fpahk@famplan.org.hk.

The Use of Personal Data for Promotional Purpose

FPAHK would like to provide our promotional information to you by email according to the contact information you have provided (including name, email address etc.). 

Even if you agree to receive FPAHK promotional information now, you may change your mind in the future. Please notify us of your name and email address through email, we will stop sending any promotional information to you.

Please tick (✓) the appropriate boxes below if you agree.

* Please tick the box
* Please tick the box
Please note: submission of the above information does not constitute acceptance of an application. Applicants are required to produce the original of valid documents when attending the clinic to confirm their eligibility for this Programme.
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