臺北醫學大學洽公人士疫情調查表
1.因應Covid-19疫情，新生註冊採預約制到校現場辦理。預約網址：https://forms.gle/kicWemuFZoVmCVpR6
2.受委託者須於到校辦理新生註冊前2天內，完成「臺北醫學大學洽公人士疫情調查表」，完成者始得入校辦理註冊。
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Email *
新生學號 Student ID number *
1.到校辦理人之姓名 Name *
2.性別 Gender *
3.聯絡電話
4.請問您最近是否同時間同地點出現於中央流行疫情指揮中心公告之確診足跡相關地點? Have you vistied the places over the time periods that CECC reminded? *
5.請問您近兩周是否有5人以上群聚史(如聚餐、唱歌、喝咖啡、逛街購物、慶生、旅遊等)？ Have you clustered over 5 people in the last 2 weeks ( including dining, karaoke, shopping, birthday party, travel, etc) *
6.請問您是否於這兩周內出現過以下症狀？（複選）Have you had the following symptoms in the last two weeks? *
7.請問您最近兩周是否出國（包含轉機）？Have you traveled outside of the country in the last two weeks（including transfer）? *
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