景能物理治療所預約表(Request an Appointment)

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請填寫正確EMAIL與電話

Email *

景能物理治療所地址:

台北市松山區光復北路3號3樓

連絡電話:

(02)2742-2753

請留意，因為我們是預約制，若確定了您的預約時間，
請【準時】或【提前抵達】，以免損失治療時間。

已了解

依照臺灣物理治療師法所規定，民眾前往物理治療所就診時，可攜帶三個月內醫師診斷證明書前來第一次的治療。如果您沒有醫師的診斷證明書，只能針對非疾病的症狀治療。如果您是外籍人士，請記得同時攜帶您的護照號碼。In Taiwan, Physical Therapy Clinic needs a Doctor to issue the original certification of diagnosis for a patient (Expiration date only 3 months). If you don't have the certification, we can do the non-disease treatment. If you are a foreigner, please brings your passport number for recording. *

是的，我會攜帶診斷證明Yes, I have the certification of diagnosis.

否，我沒有診斷證明書No, I don't have the certification of diagnosis

Required

姓名 (Full Name) *

性別

(Sex)

男性(male)

女性(female)

Other:

Clear selection

聯絡電話室內、手機皆可

(Phone number)

請填寫正確電話號碼

我們才能確認預約時間

您方便的聯繫方式

(If we contact, which is the most convenient way for you)

電話 (Phone)

電子郵件 (Email)

兩者皆可(Both of above)

請填寫您方便的聯絡時間

(Please let we know what times are convenient for you if we contact)

簡單敘述您的身體狀況

(Your Message)

請填選您期望預約諮詢或治療的日期與時段，若需要預約【當天】或【當週】時段請致電前來詢問空檔時段。或加入我們的官方Line (ID:@fxa1997o) 與我們聯繫討論是否有剩餘的空擋。
(Please choose a time for your appointment, we will contact you by phone or email. At least 7 days in advance. If you need to make an appointment for the current day or week, please call us to inquire about available times. Alternatively, you can add our official Line account (ID: @fxa1997o) to discuss whether there are any remaining available times.)

若預約在一週後時段，請等待我們與您聯繫。

請注意!!!!，以下為您希望安排的日期與時段，不一定有位子，需要等待我們的聯繫，若沒有收到我們的聯繫表示此次預約失敗 (請確認您填寫的電話與EMAIL是否正確)。

YYYY

Time

歡迎提供更多詳細資訊給我們，

讓我們更了解您的需求與狀況！

若經由介紹而有想指定的治療師可以在此告知以便為您安排。

(Please provide more information for us,let we know your demand and conditions !)

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