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社區復康服務 物理治療師 - 網上預約登記
Community Rehabilitation Service Physiotherapy - Online Pre-Registration Form
姓名 Name *
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性別 Gender *
年齡 Age
聯絡電話 Contact Mobile Number *
Your answer
電郵 Email Address
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請選擇約見地點 Preference of Service Location *
可選多於一項 You can select more than one option
是否已備註冊西醫轉介信? *
請選擇約見時間 Preference of Service Time *
每次診症是否需有人協助陪同? *
每次診症是否需要輔助器材協助? *
其他資料或查詢 Other information or enquiry
Your answer
如何得悉本中心的物理治療服務 ? How do you know our service?
可選多於一項 You can select more than one option.
閣下所提供之個人資料只供內部作存檔之用,一切資料,絕對保密。All information will be kept confidential.
After receiving your pre-registration information, our staff will contact you within 3 working days to arrange an individual therapeutic appointment. Thank you.
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