290 Orchard Road #15-10/12
Paragon Medical Tower (Lobby 2)
Singapore 238859
Phone: (65) 61001234
Fax.: (65) 62350412
Email: sales@drgohsengheng.com
 
Please, feel free to fill this order form or click to download the order form and please fax the order form to (65) 62350412

 
* request information
Date: Patient's Name:*
Address:* Postal Code:*
City:*
Phone:* Country:*
   
ITEM
QTY
ITEM
QTY
Make-up Remover
Wash 1
Wash 2
Toner 1
Astringent
Enhancer 1
Enhancer 2
Enhancer 3
Post Enhancer
Day 1
Day 2
Day 3
Night 1
Night 2
Night 3
General Face 1
General Face 2
General Face 3
Eye Enhancer
Eye (Day & Night)
Eye Cream (Day)
Eye Cream (Night)
Pimple Lotion 1
Pimple Cream 2
Pimple Night
Sunblock (White)
Sunblock (Skin)
Sunblock Rejuvenation Lotion
Loose Powder
Pigment Cream 1
Pigment Cream 2
Pigment Cream 3
Breast Firming Cream
Body Cream (Day)
Body Cream (Night)
Nipple Whitening Cream 1
Nipple Whitening Cream 2
Groin Whitening Cream 1
Groin Whitening Cream 2
Scar Cream 1
Scar Cream 2
Arm - Whitening & Smoothening 2
Leg Cream (Day)
Leg Cream (Night)
Hand Cream (Day)
Hand Cream (Night)
Hand Cream (Day & Night)
Neck Cream (Day)
Neck Cream (Night)
Neck Cream (Day & Night)
Lip Oinment
Crack Lip
Nose Lotion 1
Nose Cream 2
Eyebrow 1
Eyebrow 2
Eyebrow 3
Eyebrow 4
Face Itchy Cream (Day)
Face Itchy Cream (Night)
Body Itchy Cream (Day)
Body Itchy Cream (Night)
Itchy Face
Itchy Body
Winter Cream
Clear Soap
Herbal Soap (Brown)
Bar Soap - Body (Pink)
Body Cleanser
   
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Expiry Date (Month/Date): Security No.:
Card Holder's Name:  
 
 
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Dr. Goh Seng Heng clinic
290 Orchard Road
#15-10/12 Paragon Medical Tower (Lobby 2)
Singapore 238859
Tel. : (65) 61001234
Fax. : (65) 62350412
Email : sales@drgohsengheng.com
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