香港專業語言治療所 - 個人資料表格  KK SPEECH THERAPY (HK) - 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.

 *
**預約須知 :
**Terms and Conditions ：  
1.若閣下於就診當日身體不適，請儘早透過致電／Whatsapp 本所秘書以作跟進。閣下必須出示治療當日或兩天內的醫生證明作調動安排。若閣下未能出席之後的預約時間，則所繳費用恕不退還。

2.如需因事假需要改期，必須於原定預約至少48小時前通知治療所秘書，並且安排更改時間。

4.若雙方同意退款，本診所將收取 HKD$300 手續費。

5.本治療所保留治療安排之最終決定權。


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.

4. In a circumstance where  refund had been mutually agreed, the clinic would charge an administration fee of HKD$300.
姓名
Name
 *
性別
Gender
 *
出生日期
Date of Birth
 *
MM
/
DD
/
YYYY
年齡
Age *
職業
Occupation
電話號碼
Mobile
 *
閣下想咨詢的問題是？
What issue would you like to consult about?
 *
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:
緊急聯絡人
Emergency contact
緊急聯絡人電話號碼
Emergency contact's mobile
與患者的關係
Relationship
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