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Guarantee Letter Application

Apply for your Guarantee Letter ahead of your appointment to save time.
We'll process your application and get the GL ready before your visit.
Please fill this form up together with the required attachment. Once submitted, we will process and be in touch with you. We are continuously improving our digital journey experience for you, so please suggest feedbacks to better improve our services.

Patient Information

Requestor Information

Appointment details



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Please upload your Referral Letter / Guarantee Letter / Medical Card or any other supporting documents

File 1
File 2
File 3
Note: PDF, PNG, JPG formats are supported. File limit 5MB.

By submitting this Form, you hereby agree that KPJ Ipoh Specialist Hospital may collect, use and disclose your personal data as provided in this Form,
for the following purposes in accordance with the Personal Data Protection Act 2010 and our data protection policy.
Please visit our website at for further details on our data protection policy.