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影侍數位設計工作室 實聯制表單
因應Covid19疫情影響，請各位顧客配合最低程度的提供實名制個人資料
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姓名
*
Your answer
連絡電話
*
Your answer
近期是否有出國，或是與國外人士接觸。
*
是
否
最近是否有到訪高度警戒區域
*
是
否
於14天內是否有咳嗽發燒等呼吸道相關症狀
*
是
否
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