V-Care 專業醫護上門採樣服務預約登記表格            V-Care On-Site COVID-19 Sampling Service Registration Form 
*預約前, 請注意以下事項*  *Please note the following before making an appointment*

- 請於最少3 天前提交登記表格，客服會於1-2天內回覆
- 如預約日期少於3天, 請Whatsapp 9541-3256 聯絡客服
- 個人資料必須與證件相同，核酸之報告會根據以下資料發出

- Please submit the registration form at least 3 days in advance, customer service will reply within 1-2 days
- If the appointment date is less than 3 days from the registration date, please WhatsApp 9541-3256 to contact customer service
- All information must be the same as the official documents, and COVID-19 report will be issued based on the following information
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預約日期 Appointment Date *
MM
/
DD
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YYYY
預約時間 Appointment Time *
Time
:
報告日期 Report Date
MM
/
DD
/
YYYY
報告時間 Report Time
Time
:
上門採樣地址 On-Site Address *
英文姓名 (必須與證件相同) English Name (Same As ID) *
性別 Gender *
出生日期 DOB *
MM
/
DD
/
YYYY
手機號碼 Phone Number *
航班日期及時間（若離港，必填） Flight Date and Time (Required for outbound travelling)
MM
/
DD
/
YYYY
請選擇以下聯繫方式 Please choose the following contact option *
WhatsApp / Wechat Number 聯繫號碼 *
收取核酸報告之郵箱 Email Address for receiving COVID Report *
香港身份證號碼 HKID  *
回鄉證號碼 / 護照號碼 Mainland Travel Permit / Passport Number *
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