CAMPION CLINIC Request
Please indicate below which service you wish to apply for.

Important Note: If Chinese characters appear on your form, please click on the blue character box at the bottom of the application page to submit and complete the process. Thanks.
Which services are you interested in? *
Required
Name (Student) *
First and last name / Date of Birth
Your answer
Name (Parent) *
First and last name
Your answer
Email - Student / Parent *
Your answer
Phone number - Student/Parent *
Your answer
Current Secondary School
Your answer
Senior Curriculum - IB / A Level / HKDSE / Other
Your answer
Preferred Higher Education Destination(s) - UK/USA/Canada/Australia/HK etc
Your answer
Preferred Degree Courses / Majors (if any)
Your answer
Please add any further details you wish and indicate preferred date(s)/time(s) and we will get back to you a.s.a.p
Your answer
Submit
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