When the form is completed, you will receive a confirmation email, and the staff will reply and arrange the service as soon as possible.
Service Location:* HomeSchoolHospitalHomesOrganization / companyOthers(Please specify)
Booking Service:* Speech and swallowing assessmentSpeech and swallowing therapyCognitive and memory trainingCognitive and memory assessment
Service Date and Time:* From - to
Address:* 離島葵青北區西貢沙田大埔荃灣屯門元朗深水埗九龍城觀塘黃大仙油尖旺中西區東區南區灣仔
Other Details:
Title: SirMissMS
Name:*
Date of birth:
Tel:*
Area:* HongKongKowloonNew Territories
Address:*
Language:* English廣東話普通话
Medical Records:* HealthyHypertensionDiabetesHeart diseaseStrokeAsthmaMental illnessCancerAfter operationOthers
Take medicine / Review:
Activity level: Completely independentSemi independentCrutch / wheelchairCompletely dependentOther
Special requirements / instrumentation: