PhysioOne Physiotherapy Centre -                      Tele-consultation booking form      壹物理治療中心 - 線上諮詢預約表格
Please complete and submit the following form. After receiving your form, we will contact you within 24 hours to confirm your appointment.
請填寫並提交以下表格。 收到您的表格後，我們將在 24 小時內與您聯繫以確認您的預約。
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Email *
Last name 姓氏: *
First name 名: *
Age 年齡: *
Gender 性別: *
Contact number 聯繫電話: *
Email address 電郵地址: *
Confirm Email address 確認電郵地址: *
Reason for the consultation (please describe briefly) 諮詢原因（請簡述）: *
When did the problem start? 問題是從什麼時候開始的？: *
Do you have any of the following conditions? 您是否有以下情況: *
Required
Please indicate your preferred time and dates for the tele-consultation. We are available Monday - Saturday, 12 noon to 7:30 pm. 請註明您首選的諮詢時間和日期 (週一至週六中午 12 點至晚上 7:30 內): *
I consent to PhysioOne Physiotherapy Centre collecting the submitted information in order to handle my booking request.           我同意壹物理治療中心收集提交的資料以處理我的預約。 *
Required
You will be contacted to confirm your appointment and be informed of the fees. Sending the form does not mean the appointment has been made. If you have any questions, please email us at info@physio1macao.com             我們將與您聯繫以確認您的預約並告知費用。發送表格不代表預約成功。如有任何問題，請以電郵info@physio1macao.com聯繫我們。 *
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