First Name *


Last Name *


Email*


IC / Passport Number *


Date of Birth *


Mobile Phone Number *


Home Telephone *


Number of Pax *


Desired Screening Date (We are closed on Thurs, Sun & Public Holidays)
DD/MM/YY

Desired Screening Time
(7.40, 8.10, 8.40, 9.10, 9.40 or 10.10)am

Address *


City *


State *


Postal Code *


Country *


AntiSpam Challenge:6+3 = ? *



Terms & Conditions:

* Membership application via MJLifeScreening.com will receive a special gift worth RM150 (for a limited time!)

* This application of MJLife Health membership is for 1 pax only and a one-time investment of RM2088 (12 months installment plan option included), which comes with 1 free health screening.

* For the following years, member can enjoy health screening at only RM680 per screening for the comprehensive standard package.

* All members will be issued an MJLife member card.

* All information will be kept private. We will not share your information with any third parties.

* For more than 1 pax or family package, please call our hotline at 012-3113208 and ask for pricing.

* Other terms and conditions apply.