境外新生體檢預約之意願調查

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境外新生體檢預約之意願調查

(Intention Survey for Physical Examination reservation of Overseas Freshman)

Please read the description on the website of NCKU Health Center before fill in this form.
https://health-epsh.ncku.edu.tw/p/412-1097-17951.php?Lang=en

Last update date: 2022.02.14

預約之前..... (Before booking....)part1 *

我已閱讀學校衛生保健組網頁之相關說明，並了解預約流程。I have already read the description on the website of NCKU Health Center and understood the procedure of booking the physical examination.

Required

預約之前..... (Before booking....)part2 *

我已清楚知道自己需要哪一種新生體檢方案，並想預約成大醫院所辦之新生體檢。I have made a clearly dicision of the type of examination which provided by NCKU hospital, and want to make an appointment for it.

Required

姓名Name *

學生證號碼Student ID *

入學身分(Admission status) *

學位生 (Degree Student)

交換生 (Exchange Student)

入學年月(Admission year/month) *

111年2月 (Feb, 2022)

110年9月 (Sept, 2021)

110年9月之前 (Before Sept, 2021)

最近一次入境台灣的日期 (Which date is your last time entry to Taiwan?) *

YYYY

自主健康管理期第七日 (The last date of being isolated + self-health management) *

YYYY

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