感謝閣下的報名，抽籤結果將透過WhatsApp公佈。
有意登記成為油尖旺地區康健中心會員或參加「慢病共治計劃」人士，請填妥以下登記表。在收到閣下的登記後，本中心將有專人聯絡閣下，以辦理正式會員手續或安排參加「慢病共治計劃」。
Individuals who wish to register as members of the Yau Tsim Mong District Health Centre or participate in the CDCC Pilot Scheme are invited to complete the form below. Upon receiving your registration, our Centre’s representative will contact you to complete formal membership procedures or arrange enrolment in the CDCC Pilot Scheme.
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 Pilot 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 Pilot 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.
