health promotion center Appointment

health promotion center

Appointment

Daegu Fatima Hospital ID Number (Only for registered patients)
* Name
(First/Middle/Last Name)
*Gender Male Female
*Date of Birth
Korean ID Number -(if applicable)
*Nationality
*Language
*Phone (In Korea)
*Email Address
Address in Korea
Permanent Address
Emergency Contact Name and Relationship
Phone Number
Desired package
Desired options
*Preferred Appointment Date
*Monday –Friday available
*Diagnosis/Symptoms
(Please be specific)
*Please enter the words
you see in the box

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