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MY COACH Appointment 預約表格
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姓名 Name
*
電話 Phone
*
性別 Gender
*
男 Male
女 Female
電郵 Email
*
預約日期 Preferred Date
*
你從何得知MY PLACE的資訊？How did you know about MY PLACE?
*
「關懷愛滋」網站 AIDS Concern's Website
社交平台 Social Media Sites
訂房app廣告 Ads on Room Booking Apps
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他(可於備註註明) Others (please specify in Remarks)
備註 Remark
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MY CHECKUP Appointment 預約表格
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姓名 Name
*
電話 Phone
*
性別 Gender
*
男 Male
女 Female
電郵 Email
*
預約日期 Preferred Date
*
選擇你的套餐 Choose your package
*
體檢套餐 Checkup (Plan A)
體檢套餐 Checkup (Plan B)
體檢套餐 Checkup (Plan C)
自選套餐 “Just Check” Plan
獨立化驗項目 Individual Test
你從何得知MY PLACE的資訊？How did you know about MY PLACE?
*
「關懷愛滋」網站 AIDS Concern’s Website
社交平台 Social Media Sites
訂房app廣告 Ads on Room Booking Apps
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他(可於備註註明) Others (please specify in Remarks)
備註 Remarks
提交 Submit
MY PrEP Appointment 預約表格
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姓名 Name
*
電話 Phone
*
使用者 Client
*
現有使用者 I’m on PrEP
新使用者 I’m not currently on PrEP
電郵 Email
*
預約日期 Preferred Date
*
你從何得知MY PLACE的資訊？How did you know about MY PLACE?
*
「關懷愛滋」網站 AIDS Concern’s Website
社交平台 Social Media Sites
訂房app廣告 Ads on Room Booking Apps
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他(可於備註註明) Others (please specify in Remarks)
備註 Remark
提交 Submit
