個人資料表格  Personal Information Form
本表格用於收集顧客基本個人資料，以便為您提供更好的服務。填寫報名表格前，請先細閱下列「收集個人資料聲明」、「預約須知」。
This form is used to collect basic personal information from customers in order to provide you with better service. Please carefully read the "Personal Information Collection Statement" and "Appointment Instructions" before filling out the registration form.
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**收集個人資料聲明：
香港專業語言治療所（下稱「本所」）會遵守及履行個人資料（私隱）條例之規定，並確保你的個人資料準確及安全。

你所填寫的個人資料（包括姓名、電子郵件地址及其他）或會被本會透過電話／郵寄／電子郵件，用作聯絡通訊、籌款、推廣活動、研究調查及其他通訊及推廣之用途。

• 香港專業語言治療所舉辦/合辦或其他相關機構舉辦的活動或講座；

• 香港專業語言治療所或其他相關機構提供的優惠/折扣/推廣活動；

• 為慈善/公益/教育/社區或其他目的邀請捐贈/貢獻/參與。

除非得到你的同意，本所不會使用你的個人資料作直接促銷。如閣下希望語言治療所在直接促銷中使用閣下的個人資料，請你在下列方格內加上剔號("✓")。閣下可隨時以書面或電子郵件(enquiry@kkspeechtherapy.com)向本所申明是否願意繼續接受有關諮詢。

Personal Information Collection Statement:

KK Speech Therapy (HK) adheres to and fulfills the provisions of the Personal Data (Privacy) Ordinance, ensuring that your personal data is accurate and secure.

The personal information you provide (including name, email address, and others) may be used by the Institute through phone, mail, or email for the purposes of contact communication, fundraising, promotional activities, research surveys, and other communications and promotional uses.

• Activities or seminars organized/co-organized by KK Speech Therapy (HK) or other related organizations;

• Offers/discounts/promotions provided by  KK Speech Therapy (HK) or other related organizations;

• Invitations to donate/contribute/participate for charitable/public welfare/educational/community or other purposes.

Unless we have your consent, your personal data will not be used for direct marketing. If you wish for your personal data to be used in direct marketing by  KK Speech Therapy (HK)  , please mark the checkbox ("✓") below. You may at any time declare in writing or via email (enquiry@kkspeechtherapy.com) whether you wish to continue receiving related consultations.

Clear selection
**預約須知 :
**Terms and Conditions ：
1.若學員於課堂當日身體不適，請儘早透過致電／Whatsapp 本所秘書以作跟進。學員必須出示訓練當日或兩天內的醫生證明作補課安排。若參加者未能出席補課，則所繳費用恕不退還。

2.如需因事假需要改期，必須於原定課堂至少48小時前通知治療所職員，並且安排補課時間。

3.事假改期細則：每個月最多只可一次，多於一次改動將不獲補課安排，敬請注意。

4.若雙方同意退款，本診所將收取 HKD$300 手續費。

5.本治療所保留課堂安排之最終決定權。


1. If sick leave were to be taken, please provide a doctor's certificate for our record, a compensated session will then be arranged. No compensated session will be arranged if a doctor's certificate is not provided.

2. If rescheduling is necessary, please contact us at least 48 hours before the session for rearrangement. No compensated session will be arranged if the 48-hr notice period is not fulfilled.

3. Only one rescheduling is allowed per month.

4. In a circumstance where  refund had been mutually agreed, the clinic would charge an administration fee of HKD$300.
**颱風及暴雨警告下活動安排（不適用於線上治療服務）:
**Activity Arrangement under Typhoon and Rainstorm Warning (Not applicable for online therapy services)   :
1.若懸掛一號風球或黃色暴雨警訊號，訓練照常進行，治療所繼續提供服務

2.若懸掛三號風球或紅色暴雨警訊號，訓練照常進行，治療所繼續提供服務。

3.若天文台宣布兩小時內懸掛八號風球或黑色暴雨警訊號，治療所的所有活動取消。治療所即暫停服務。訓練時段會再作安排。

4.若天文台於早上宣布兩小時內將除下八號風球或黑色暴雨警告訊號，治療所將於下午二時照常提供服務。

5.若天文台在下午二時後宣布除下八號風或黑色暴雨警告號，治療所當日之服務取消。

1 If Typhoon Signal No. 1, Typhoon Signal No. 3, or Amber Rainstorm Warning Signal is hoisted, session will continue as usual, and the clinic will continue to provide services.

2. If a Typhoon Signal No.8 or Black Rainstorm Warning has been issued by the Hong Kong Observatory within two hours of session, all services will be cancelled. The clinic will be temporarily suspended. Training sessions will be rescheduled.
學員姓名（中文）
Client Name （Chinese）
學員姓名（英文）
Client Name （English）
 *
性別
Gender
 *
出生日期 
Date of Birth
 *
MM
/
DD
/
YYYY
學員年齡
Age *
主要使用的語言
Mainly spoken languages
 *

以往是否曾接受心理學家/語言治療師的專業治療？
Has your child previously received professional treatment from a psychologist or speech therapist?

 *
孩子是否被診斷過有以下症狀？
Has your child been diagnosed with any of the following symptoms?
 *
Required
家長最重視學童哪一方面的能力/問題（可選多項）?
What aspects of your child's abilities/issues do you value most (multiple selections possible)?
 *
Required
如需要上門服務，請提供詳細地址：
If home service is required, please provide a detailed address:
就讀學校 及 班別
Current school & Attend class
父親姓名
Father's name
職業
Profession
母親姓名
Mother's name
職業
Profession
監護人聯繫電話
Contact number
 *
緊急聯繫人姓名
Emergency Contact Person
 *
聯繫電話
Contact number
 *
與學員關係
Relationship
 *

你得知本言語治療所的途徑是？
How did you learn about us?

 *
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