Incident Report Form

Incident Report Form

We may require you to provide us with personal data (which may include health data) in order to provide you with assistance in relation to this incident. Where you disclose personal data to us for this purpose, you consent to us collecting that personal information which you acknowledge may include details about your medical and treatment history. Further information with respect to how we use and disclose personal data is outlined in our Privacy Policy.

Kindly fill up the form below if you would like to lodge an incident report.

Leave this field empty if you are using the same contact email
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