6月13日 健康躍動日

姓氏 Surname*:

性別 Gender*:
男 Male女 Female

年齡組別 Age Group*:
18歲以下 (Under 18)18 - 2425 - 4445 - 6465 - 8080歲以上 (Over 80)

閣下希望參加「慢病共治計劃」
I wish to join the CDCC Scheme*:
是 (Yes)否 (No)

閣下已被確診患有糖尿病或高血壓
Have you been diagnosed with diabetes or hypertension?*:
否 (No)不確定 (Not sure)是 (Yes)

註：「慢病共治計劃」參加資格：45歲或以上香港居民及沒有已被確診患有糖尿病或高血壓
Note: Eligibility for the CDCC Scheme — Hong Kong residents aged 45 or above* and no known medical history of diabetes mellitus or hypertension

聯絡電話 Contact Number*:

閣下同意並接受《私隱政策條款及細則》*
I agree to and accept the Privacy Policy and Terms of Use.*

閣下同意收取來自油尖旺地區康健中心有關活動及服務的電子通訊及 WhatsApp。
I agree to receive electronic messages and WhatsApp updates about activities and services from the Yau Tsim Mong District Health Centre.