Health Assessment

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In compliance with TCMPB (Traditional Chinese Medicine Practitioners Board) and MOH regulations, we will require all patients to complete the following forms for record purposes. The Personal Data Protection Act (PDPA) protects your personal data while enabling us to use your data reasonably to serve you, your information will be kept confidential and only be used for service administration purposes within our organization or with other medical institutions if required by law.

根据 TCMPB(中医师委员会)和卫生部的规定,我们将要求所有患者填写以下表格以供记录。《个人资料保护法》(PDPA) 保护您的个人资料,同时使我们能够合理使用您的资料来为您提供服务,您的资料将被保密,并且仅在法律要求的情况下用于我们组织内或与其他医疗机构的服务管理目的。

Note: If you are intending to make insurance claims for your treatments, it is compulsory for you to first receive consultation from any of our physicians prior to any treatments administered (including Tui Na). This regulation applies to all patients including TCM/Wellness Plan Members.

注意:如果您打算为您的治疗提出保险索赔,则在进行任何治疗(包括推拿)之前,您必须首先接受我们任何医师的问诊。本规定适用于所有患者,包括 现有治疗计划会员。
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Are you intending to make insurance claims for your TCM treatments? 您打算为您的中医治疗提出保险索赔吗?

PATIENT PARTICULARS 患者个人资料

Date of Birth 出生日期
Gender 性别