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      1. 歡迎來到寧波市鄞州人民醫院醫共體!
        弱女子的心

        在線服務

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        Appointment Form

        預約單

        The form is for you to make an appointment online for international medical servicess

        請您填寫以下表單,用于預約國際醫療服務

        Name/姓名:(If you have insurance card, your name must be consistent with that on your insurance card.)

        Gender/性別:

        Date of Birth/出生日期:

        Nationality/國籍:

        Medical Insurance No./醫保賬號:

        E-mail Address/電子郵箱:

        ID or PassportNumber/身份證或護照編號:

        Phone/電話:

        Present Address/現居地:

        Appointment Date/預約日期:

        Appointment Time/時間:

        Short Description of Your Complaints/主要癥狀與體征:

        Medical History/病史:(Such as Hypertension Diabetes/Allergy of Food or Medication/Non Special/other)

        Medications you are taking/正在服用的藥物(Please declare no when you are not taking any medication)

        Special Needs/特殊需求:Such as a wheel chair/language support except English

        *Your information will absolutely be kept confidential. Please bring your photocopies of your passport and insurance card (both sides copy needed) if you have medical insurance.

        * 您的就醫信息將被嚴格保密。如您有醫療保險,請攜帶您的護照和保險卡復印件(雙面復印)