Filos Functional Screening Registration Form 天友身体功能检测登记表
This form is for the purpose of assessing your eligibility for Filos Functional Screening and to schedule you for it if you are eligible.  

If you are eligible for our functional screening, we will contact you prior to the event date to inform you of your eligibility and any applicable next steps. You may also walk-in on the event day if you do not receive any call from us.  

本表格旨在评估您是否符合参加 Filos 功能筛查的资格；若符合资格，我们将为您安排筛查时间。 如果您符合功能筛查的资格，我们会在活动日期前与您联系，告知您的资格确认情况及后续安排。若您未收到我们的来电，也可在活动当天直接前往现场。
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Details of Functional Screening

Date 日期: 28 Sept 2026 (Monday)
Time 时间: 9am – 5pm
Location 地点: Blk 23A Chai Chee Pavilion, Singapore 461023

Registration Form Closes 报名表截止日期: 25 Sept 2026 (Friday 星期五)
Last Walk-in Timing 最后接待时间: 4.30pm 

What we screen for 筛查项目: 
👁️ Eyesight 视力
👂 Hearing 听力
🦷 Oral Health 口腔健康
🧠 Mental Health 心理健康
🚶‍♂️ Fall Risk 跌倒风险
1. Consent 同意 *
By submitting this form, you consent and agree that your information (including all information previously collected or obtained under Filos, where applicable) may be collected, used, disclosed and/or retained by the Healthcare Clusters and their respective third-party service providers, for the purpose of administering functional screening, including but not limited to assessing your eligibility for Filos Functional Screening and scheduling you for it.
提交本表格即表示您同意并确认，医疗保健集群及其各自的第三方服务提供商可收集、使用、披露和/或保留您的信息（包括此前在 Filos 框架下收集或获取的所有相关信息），以便开展功能筛查工作，其中包括但不限于评估您参与 天you 功能筛查的资格以及为您安排筛查时间。
2. Age 年龄 *
3. NRIC No. 登记号码 *
Only Singaporeans and Permanent Residents are eligible for Functional Screening
只有新加坡公民和永久居民才有资格接受功能性筛查。
4. Full Name 全名 *
(as in NRIC)
5. Date of Birth 出生日期 *
MM
/
DD
/
YYYY
6. Preferred Contact Number 首选联系电话 *
7. Alternative Contact Number 备用联系电话
(optional 选修的)
8. Postal Code 邮政编码 *
Must be your current place of residence 
必须是您的当前居住地
9. Block Number/ House Number 楼号/门牌号 *
10. Street Name 街道名称 *
11. Building Name 建筑物名称
(optional 选修的)
12. Unit Number  门牌号
(optional 选修的)
13. Will you be interested in a free kidney screening? 
您是否有兴趣接受免费的肾脏筛查？
 *
The sponsored screening is available for Singapore Citizens and Permanent Residents aged 21 to 80 years with one or more of the following risk factors:
这项受资助的筛查服务适用于年龄在21至80岁之间、且具备以下一项或多项风险因素的新加坡公民及永久居民：
  • Diabetes 糖尿病
  • Hypertension 高血压
  • Heart disease 心脏病
  • Family history of kidney disease 肾脏病家族史
  • Family history of diabetes 糖尿病家族史
  • Family history of hypertension 高血压家族史
  • BMI ≥ 27.5 kg/m²
  • Regular smoking 长期吸烟
  • Frequent use of non-steroidal anti-inflammatory drugs 频繁使用非甾体抗炎药 (NSAIDs)
Participants who do not fulfil the eligibility criteria may still participate at a subsidised fee of S$15 (before GST). 不符合资格标准的参与者仍可参加，费用为优惠价 15 新元（不含消费税）

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