看诊预约登记（Medical Appointment Registration）

添加问卷说明填写信息提交后，专属客服会致电给您预约具体看诊时间。

After submitting the completed questionnaire information, a dedicated service representative will contact you by phone to schedule your medical appointment.
*
1.
患者姓名？
Patient Name
*
2.
出生日期？
Date of Birth
*
3.
联系方式？
Contact Information
*
4.
看诊哪方面疾病？
Regarding which medical condition
【请选择1-6项】
鼻敏感(Nasal Allergy)
鼻鼾(Snoring)
鼻出血(Nosebleed)
听力问题(Hearing Problems)
视力问题(Vision Problems)
其他(Other)
5.
您期望的就诊时间（每周周一、周二休诊）
Preferred Appointment Date(Note: Closed every Monday and Tuesday)
*
6.
您想预约的院区
Which branch would you like to schedule your appointment at?
上海长宁院区(Shanghai Changning Branch)
杭州501院区Hangzhou 501 Branch)
杭州西溪院区(Hangzhou Xixi Branch)
广州天河院区(Guangzhou Tianhe Branch)
深圳福田院区(Shenzhen Futian Branch)
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