Service Request - The Family Planning Association of Hong Kong

Service *

Youth HPV 9-1 Vaccination service (for unmarried Hong Kong residents under 26 years of age only)

Online Reservation Fee HK$ 0

Venue *

Wan Chai Clinic (G/F)
Wan Chai Sexual & Reproductive Health Centre (9/F)
Ma Tau Chung Clinic (G/F)
Ma Tau Chung Clinic (1/F)
Ma Tau Chung Clinic (2/F)
Wong Tai Sin Clinic
Yuen Long Clinic (G/F)
Yuen Long FPAHK Anita Mui Health Centre (1/F)
Tsuen Wan Clinic
Wan Chai Youth Health Care Centre
Mong Kok Youth Health Care Centre
Kwai Fong Youth Health Care Centre

* Please select Venue

Venue *

* Please select Venue

Meeting Time *

First Choice

Second Choice

Third Choice

* Please select Meeting Time

Appointment Detail *

Available time on

* Please select Appointment Time

Available Date

Selected Date

Before filling the form below, please select the date and time first!

First Name *

* Please input First Name

Last Name *

* Please input Last Name

Gender *

Female

Male

* Please select Gender

Email Address *

* Please input Email Address

* Please input a valid Email Address

Phone Number *

(Day)

* Please input Phone Number(Day)

* Please input a valid Phone Number(Day)

(Night)

* Please input Phone Number(Night)

* Please input a valid Phone Number(Night)

Fax Number

* Please input Fax Number

* Please input a valid Fax Number

No. of Paticipants *

* Please select No. of Paticipants

First Name *

* Please input First Name

Last Name *

* Please input Last Name

Email Address *

* A copy of your booking details will be sent to your email upon submission

* Please input Email Address

* Please input a valid Email Address

Phone Number *

(Day)

* Please input Phone Number(Day)

* Please input a valid Phone Number(Day)

(Night)

* Please input Phone Number(Night)

* Please input a valid Phone Number(Night)

Fax Number

* Please input Fax Number

* Please input a valid Fax Number

First Name *

* Please input First Name

Last Name *

* Please input Last Name

Email Address *

* A copy of your booking details will be sent to your email upon submission

* Please input Email Address

* Please input a valid Email Address

Phone Number *

(Day)

* Please input Phone Number(Day)

* Please input a valid Phone Number(Day)

(Night)

* Please input Phone Number(Night)

* Please input a valid Phone Number(Night)

Fax Number

* Please input Fax Number

* Please input a valid Fax Number

Marital Status *

Going to get married in

* Please input Year

Cohabitation for

* Please input Length

month(s)

Has child

Married for

* Please input Length

month(s)

Has child

* Please select Marital Status

The Collection and Use of Personal Data Statement

Personal data collected by The Family Planning Association of Hong Kong (FPAHK) will be used for the service booking and communication purpose. Apart from the above usage, all personal data will be kept confidential, handled strictly in accordance with applicable laws and will not be transferred to any organizations or parties.

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.

For contact information of FPAHK, please visit our website.

Please tick the appropriate boxes below if you agree.

I have read, understood and agreed with "The Collection and Usage of Personal Data Statement" mentioned above. *

* Please tick the box

I have read, understood and agreed with "The Use of Personal Data for Promotional Purpose" mentioned above and agree to receive FPAHK promotional information.

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