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心理治療線上預約申請表
您好,請您留下基本資訊,以協助我們建立您的個人資料與瞭解您的狀況。
若表單填寫完成,我們將有專人於工作日 ( 每週一至週五,08:00~17:00 ) 與您聯繫並確認預約時間,僅於上班時間方有人員撥接電話,望您見諒。( 若於非工作日填寫表單,則我們將於下個工作日盡快與您聯繫)
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個人資料使用同意書
*
依據個資法,我們需要您同意提供填寫資料予信安醫院使用,我們不會對外洩漏個資。
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