Eyescreen™ Registration

EyescreenTM Eligibility
The child
  • should be aged between 6 months to 6 years.
  • not administered with any eye treatment or prescribed with glasses.
  • has not been detected with any eye condition.


Number of children to register*
Required.

For First Child

Child's Full Legal Name*
Required.

Is your child above 6 years old? *
Required.

Has your child been administered with any eye treatment or been prescribed with glasses? *
Required.



Location*
Invalid Input

Date of Appointment

Check slots availability
1 slot left
fully booked
Date of Screening*
Required.

Time of Screening*
Please choose an available time.

Child's Information

Has your child used our Eyescreen service before?*
Required.

*We will require the last 3-digits+alphabet of your child's Birth Certificate No. for verification

Child's Birth Certificate No.* (Example - 000A)
Required.

Child's Date of Birth*
Required.

The child should be aged between 6 months to 6 years

Gender*
Required.

Child's Medical History

Was your child born full term? *
Required

If it was a premature birth, please indicate the gestation week delivered *
Required.

Was there any childbirth complication?*
Required.

It yes, please state: *
Invalid Input

Has your child been diagnosed of any medical condition?*
Invalid Input

It yes, please state: *
Required.

Has your child been diagnosed of any medical condition after the previous visit?(*)
Invalid Input

It yes, please state: (*)
Required.

Has your child visited an eye/vision screening provider before? *
Required.

Has your child visited an eye/vision screening provider after the previous visit?(*)
Invalid Input

If yes, please state

Invalid Input
please indicate
Invalid Input

Invalid Input
please indicate:
Invalid Input

Invalid Input

please indicate
Invalid Input

When was your child last eye/vision screening?

Invalid Input

What was your child's screening result from the last eye/vision screening?*

Invalid Input

Please specify : *
Invalid Input

If yes, please state

Invalid Input

please indicate Hospital / Polyclinics
Invalid Input

please indicate School / Kindergarten
Invalid Input

please indicate
Invalid Input

When was your child last eye/vision screening?

Invalid Input

What was your child's screening result from the last eye/vision screening?

Invalid Input

Has your child been suspected of having any eye condition? *
Required.

If yes, please state*
Required.

Has your child been suspected of having any eye condition after the previous visit?(*)
Invalid Input

It yes, please state: (*)
Required.

Is there a family history of any eye condition? *
Required.

If yes, please state:*
Requried.

For Second Child

Child's Full Legal Name*
Required.

Is your child above 6 years old? *
Required.

Has your child been administered with any eye treatment or been prescribed with glasses? *
Required.



Date of Appointment

Check slots availability
1 slot left
fully booked
Date of Screening*
Required

Time of Screening*
Please choose an available time.

Child's Information

Has your child used our Eyescreen service before?*
Invalid Input

*We will require the last 3-digits+alphabet of your child's Birth Certificate No. for verification

Child's Birth Certificate No.*
Required.

Child's Date of Birth*
Required.

The child should be aged between 6 months to 6 years

Gender*
Required.

Child's Medical History

Was your child born full term*
Required

If it was a premature birth, please indicate the gestation week delivered *
Required.

Was there any childbirth complication?*
Required.

It yes, please state: *
Invalid Input

Has your child been diagnosed of any medical condition?*
Required.

It yes, please state: *
Required.

Has your child been diagnosed of any medical condition after the previous visit?(*)
Invalid Input

It yes, please state: (*)
Required.

Has your child visited an eye/vision screening provider before? *
Required.

Has your child visited an eye/vision screening provider after the previous visit?(*)
Invalid Input

If yes, please state

Invalid Input

please indicate
Invalid Input

Invalid Input

please indicate:
Invalid Input

Invalid Input

please indicate
Invalid Input

When was your child last eye/vision screening?

Invalid Input

What was your child's screening result from the last eye/vision screening?*

Invalid Input

Please specify : *
Invalid Input

If yes, please state

Invalid Input

please indicate Hospital / Polyclinics
Invalid Input

please indicate School / Kindergarten
Invalid Input

please indicate
Invalid Input

When was your child last eye/vision screening?

Invalid Input

What was your child's screening result from the last eye/vision screening?

Invalid Input

Has your child been suspected of having any eye condition? *
Required.

If yes, please state*
Required.

Has your child been suspected of having any eye condition after the previous visit?(*)
Invalid Input

It yes, please state: (*)
Required.

Is there a family history of any eye condition? *
Required.

If yes, please state:*
Requried.

For Third Child

Child's Full Legal Name*
Required.

Is your child above 6 years old? *
Required.

Has your child been administered with any eye treatment or been prescribed with glasses? *
Required.



Date of Appointment

Check slots availability
1 slot left
fully booked
Date of Screening*
Required

Time of Screening*
Please choose an available time.

Child's Information

Has your child used our Eyescreen service before?*
Invalid Input

*We will require the last 3-digits+alphabet of your child's Birth Certificate No. for verification

Child's Birth Certificate No.*
Required.

Child's Date of Birth*
Required.

The child should be aged between 6 months to 6 years

Gender*
Required.

Child's Medical History

Was your child born full term?*
Required

If it was a premature birth, please indicate the gestation week delivered *
Required.

Was there any childbirth complication?*
Required.

It yes, please state: *
Invalid Input

Has your child been diagnosed of any medical condition?*
Required.

It yes, please state: *
Required.

Has your child been diagnosed of any medical condition after the previous visit?(*)
Invalid Input

It yes, please state: (*)
Required.

Has your child visited an eye/vision screening provider before? *
Required.

Has your child visited an eye/vision screening provider after the previous visit?(*)
Invalid Input

If yes, please state

Invalid Input

please indicate
Invalid Input

Invalid Input

please indicate:
Invalid Input

Invalid Input

please indicate
Invalid Input

When was your child last eye/vision screening?

Invalid Input

What was your child's screening result from the last eye/vision screening?*

Invalid Input

Please specify : *
Invalid Input

If yes, please state

Invalid Input

please indicate Hospital / Polyclinics
Invalid Input

please indicate School / Kindergarten
Invalid Input

please indicate
Invalid Input

When was your child last eye/vision screening?

Invalid Input

What was your child's screening result from the last eye/vision screening?

Invalid Input

Has your child been suspected of having any eye condition? *
Required.

If yes, please state*
Required.

Has your child been suspected of having any eye condition after the previous visit?(*)
Invalid Input

It yes, please state: (*)
Required.

Is there a family history of any eye conditions? *
Required.

If yes, please state:*
Requried.

Parent’s/ Guardian’s information

Are you a Cordlife client?*
Required.

*We will require your Date of birth, contact, and Email for verification

Mother's Full Legal Name*
Required.

Mother's Date of Birth : *
Required.

Full Legal Name*
Required.

Contact Number: *
Required.

Email Address :*
Required.

Sorry, you are not eligible for Cordlife Client discount. Please contact us if you think this is an error.
Where did you hear about Eyescreen™?*

Invalid Input

please indicate :
Invalid Input

Please bring along referral letter on the day of appointment, if any
please indicate:
Invalid Input

please indicate:
Invalid Input

Appointment Details

Guardian Name: .

Email: .

Number of Children: .

First Child Name: .

First Child Screening Date: .

First Child Screening Time: .

Payment summary

Please key in Eyescreen Promotion / Voucher Code for discount if you have any
Invalid Input

Promotion [1-for-1 Eyescreen & Earscreen Bundle]
Invalid Input

Payment for First Child
Payment for Second Child
Payment for Third Child
Discount
Only one discount per registration is allowed, whichever the greatest savings / discount will be applied.
Total Payment
0.00 SGD

Payment Type*
Invalid Input

Required.
  • I consent to the performance of the Eyescreen™ service on my child. As with any health screening, false positive or false negative results cannot be completely eliminated due to various reasons, including but not limited to, age of child at the time of screening, child’s health status, and other variables. Hence, the risk of a vision disorder should never be precluded solely on the basis of this screening. Signs or symptoms observed should be followed up immediately by a Paediatric Ophthalmologist.
  • The booking of Eyescreen™ sessions is subject to slots availability and on a first-come-first-served basis.
  • All prices are indicated in SGD, and are inclusive of Goods & Services Tax (GST).
  • Once an Eyescreen™ session is registered, it is non-refundable and cannot be exchanged for other services or cash.
  • By submitting this form, I consent to the processing of my personal data by Eyescreen™, Genscreen®, Cordlife and its related corporations (collectively, the "Cordlife Group"), for marketing and/or research purposes, and agree to be contacted for any products and/or services updates, news, promotions, information via calls, SMS and/or emails.
Cordlife Technologies Pte Ltd (“Cordlife”), a wholly owned subsidiary of Cordlife Group Limited (“CGL”), treats all information provided in the above Eyescreen™ registration (“Collected Data”) as confidential and in accordance with the relevant laws of Singapore. To the extent necessary for performing the Eyescreen™ Service (“Service”), the Collected Data will be transferred to the licensed optometrist providing the Service. Otherwise, the Collected Data will not be transferred to any other third party without your prior consent, unless required by any competent court or judicial, governmental or regulatory body or pursuant to any relevant law or regulation.

We don't have your child's birth certificate [] in our database.

Please contact us if you think this is an error
My child has not attended EyescreenTM before
I might have keyed in the wrong Birth Certificate No.