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Health Consultion
  1. Please fill in your information below, we will serve as soon as possible.
  2. Medical Report Consultation: Please remember to bring your report to our office for consultation.
  3. Health Care and Medical Consultation: Please bring your own medical equipment to our office for consultation or demonstration.
  4. Registration for medical equipment demonstration prior to activities:   

a) Please call 03-5743000 or #43000 one month before to discuss and confirm demonstration time before filling the form.

b) “ID”, please fill in all participating members name and student number. Example: 101000000 Tony.

c)  Each session students are limited from 5 to 10 people ( at least 5). If more than that, please separate into two sessions, thank you. 

 

*Department:
*Name:
*Mobile phone:
*E-mail:
*Subject/Question:
Medical report  Specific disease care  Health care & medical consultation  First aid kit demonstration 
*Appointment date: Calendar
*Appointment time:
09:00~10:00 
10:00~11:00 
11:00~12:00 
14:00~15:00 
15:00~16:00 
16:00~17:00 
ID/Name: ,,,,
ID/Name: ,,,,
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