top of page
入學表格

個人信息

一般信息

Do you use tobacco products?
Do you regularly use any cannabis products?
Do consume any alcohol?
Do you take any nutritional / natural supplements?
Do you have any allergies?
Do you have any medical conditions or diseases?
Do you currently take any prescriptions?

病史

您是否被告知您有以下任何情況:

Ischemic heart disease/ Previous Heart attack
Ischemic heart disease/ Previous Heart attack
Atrial Fibrillation
Diabetes
COPD
Asthma
Hypertension
CVA/ Stroke / TIA or mini-stroke
Thyroid Problems
Arthritis
Depression
Anxiety

家史

非處方 (OTC) 產品的使用

請選擇您當前服用的相關非處方藥。

感謝您的信任!

bottom of page