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← 诊所、化验室与药房

新患者登记

首次就诊前的联系信息,并征得同意。不含医疗问题:可自行添加。

问题

  1. 01Full name简答
  2. 02Date of birth日期
  3. 03Gender单选
  4. 04Mobile number电话
  5. 05Emergency contact (name and phone)简答
  6. 06How did you hear about us?单选
  7. 07I agree that the clinic may keep these details to arrange my care and contact me about it.同意