護理服務搜尋者註冊表

Healthcare Seeker Registration Form

所有標註「＊」之欄位為必填項，請完整填寫。

All fields marked with “＊” are required. Please fill them out completely.

名 (Given names)

姓 (Surname)

出生日期 (Date of birth)

Day

Month

Year

性別 (Sex)

男性 (Male)

女性 (Female)

電子郵件 (E-mail Address)

聯絡電話 (Contact No.)

最近入住醫院名稱

(Name of the hospital recently admitted)

最後一次入院的日期(Date of last hospital admission)

港島東醫院聯網 (Hong Kong East Cluster)

港島西醫院聯網 (Hong Kong West Cluster)

九龍中醫院聯網 (Kowloon Central Cluster)

九龍東醫院聯網 (Kowloon East Cluster)

九龍西醫院聯網 (Kowloon West Cluster)

新界東聯網 (New Territories East Cluster)

新界西聯網 (New Territories West Cluster)

私立醫院 (Private Hospitals)

By submitting this form, you explicitly agree to the terms and conditions outlined below, signifying your consent and acceptance of those terms.

勾選此方框即表示你明確同意以下所列的條款及細則，並表示你已閱讀、理解及接受這些條款。