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觀昕診所

Health declaration

Please fill out the following form.

First name

Last name

Email*

Date of birth

年

月

天

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

觀昕診所

觀昕診所觀昕藥局

觀昕醫檢中心

佳藝診所

地址：黎明東街150 2-1 -2

地址：豐原區豐勢路二段388

info@kcclinicgroup.com

預防醫學診所

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