Faithmed Chinese Medicine Clinic Appointment Request form

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Good day, if you wish to make an appointment, please fill in this form and clink "Send" when finished.
Our staff will contact you to follow up your appoinment making as soon as possible through phone-call, Whatsapp, Signal or Email.
*You are going to receive a [Confirmation of appointment] message form our reception staff when the appointment is successfully made.

*Our Clinic main number +852 5542393 is only for:
1. Making an appointment / Enquiry / Cancellation
2. Address related enquiry
3. Consultation / Treatments fee-related enquiry
If you have any medical-related enquiry, please make an appointment of consultation for a detailed inspection performed by our CMP.

Remark - Faithmed Chinese Medicine Clinic appreciate your cooperation and understanding
- Our clinic is by appointment only.
- Please make sure of your availability before making an appointment in order to promote the efficacy of the clinic's work and maintain a smooth operation.
-We suggest you make your appointment 1 or 2 days before your designated date in order to promote the efficacy of the clinic's work and maintain a smooth operation.
-Our reception staff may reject making an appointment with you according to the process and records of changes/cancellations in your appointment-making.

Email *

Please provide your mobile phone number with Whatsapp or Singal Apps *

What date would you like to make an appointment? *

YYYY

What time do you prefer?
*

Time

Are you making this appointment for youselves or for others?
*

If you are making an appointment for another person, please check "Other" and kindly provide the mobile phone number of the patient coming behind

For myself

Other:

Required

Are you coming for Medicine/ Acupuncture / other treatments?

(Consultation is included in all items below) *

Internal Medicine (Concentrated Chinese Medicine decoction Powder / Traditional Herbs)

Acupuncture

Manual Therapy for musculoskeletal pain

Spinal Manipulation Therapy

Cupping

Scraping (Traditional IASTM)

Blood - Letting

Ear Acupressure

Chinese Medicine Information only (No treatment)

I am not sure (If you are not sure about which kind of treatment is suitable for you, we can make an appointment for "Consultation/Other" first. Our Chinese Medical Partitioner will discuss with you your treatment options.)

Other:

Required

Does that patient need a chaperone?
(Anyone who enters the clinic area other than the patient is a chaperone.)

*The chaperone must abide by the "Chaperone Guidelines" of this clinic.
*The chaperone must accompany the patient throughout the entire process, including entering the consultation room and treatment room.
*

If you need a chaperon please check both "Yes" and "Other" and kindly provide the mobile phone number of the chaperone in the "Other" section

Yes

Other:

Required

Is it the first time you / the patient coming to our clinic?
*

Yes

What is the main symptom of you / the patient?

Submit

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