{"id":96,"date":"2022-10-22T14:38:19","date_gmt":"2022-10-22T14:38:19","guid":{"rendered":"http:\/\/guoantangtcm.com\/?page_id=96"},"modified":"2022-12-01T05:12:03","modified_gmt":"2022-12-01T05:12:03","slug":"health-declaration","status":"publish","type":"page","link":"https:\/\/guoantangtcm.com\/zh\/health-declaration\/","title":{"rendered":"Health Declaration"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"96\" class=\"elementor elementor-96\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-55f99d7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"55f99d7\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-4692ad1\" data-id=\"4692ad1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-0299d5b\" data-id=\"0299d5b\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-eb8bcb8 elementor-widget elementor-widget-heading\" data-id=\"eb8bcb8\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"><h2 data-hook=\"title\" data-appearance=\"H2\" data-light=\"false\" style=\"font-weight: var(--wsr-font-weight-bold, 400); margin: 0px 0px 10px; font-family: var(--wsr-font-family, HelveticaNeueW01-65Medi, HelveticaNeueW02-65Medi, HelveticaNeueW10-65Medi),&quot;Helvetica Neue&quot;,&quot;Helvetica&quot;,&quot;Arial&quot;,&quot;\u30e1\u30a4\u30ea\u30aa&quot;,&quot;meiryo&quot;,&quot;\u30d2\u30e9\u30ae\u30ce\u89d2\u30b4   pro w3&quot;,&quot;hiragino kaku gothic pro&quot;,&quot;sans-serif&quot;; font-size: 28px; line-height: 36px; word-break: break-word; text-align: center; white-space: normal;\">TCM SG Health Declaration&amp;Consent Form&nbsp;<\/h2><h2 data-hook=\"title\" data-appearance=\"H2\" data-light=\"false\" style=\"font-weight: var(--wsr-font-weight-bold, 400); margin: 0px 0px 10px; font-family: var(--wsr-font-family, HelveticaNeueW01-65Medi, HelveticaNeueW02-65Medi, HelveticaNeueW10-65Medi),&quot;Helvetica Neue&quot;,&quot;Helvetica&quot;,&quot;Arial&quot;,&quot;\u30e1\u30a4\u30ea\u30aa&quot;,&quot;meiryo&quot;,&quot;\u30d2\u30e9\u30ae\u30ce\u89d2\u30b4   pro w3&quot;,&quot;hiragino kaku gothic pro&quot;,&quot;sans-serif&quot;; font-size: 28px; line-height: 36px; word-break: break-word; text-align: center; white-space: normal;\">\u56fd\u5b89\u5802\u5065\u5eb7\u58f0\u660e&amp;\u6cbb\u7597\u540c\u610f\u4e66<\/h2><span data-hook=\"description\" data-size=\"medium\" data-secondary=\"false\" data-skin=\"standard\" data-light=\"false\" data-weight=\"thin\" data-list-style=\"checkmark\" style=\"white-space: pre-line; color: var(--wsr-text-color-primary, #162D3D); word-break: break-word; font-size: medium; line-height: 24px; font-weight: 400; font-family: var(--wsr-font-family, HelveticaNeueW01-45Ligh, HelveticaNeueW02-45Ligh, HelveticaNeueW10-45Ligh),&quot;Helvetica Neue&quot;,&quot;Helvetica&quot;,&quot;Arial&quot;,&quot;\u30e1\u30a4\u30ea\u30aa&quot;,&quot;meiryo&quot;,&quot;\u30d2\u30e9\u30ae\u30ce\u89d2\u30b4   pro w3&quot;,&quot;hiragino kaku gothic pro&quot;,&quot;sans-serif&quot;; text-align: center;\">Please take a minute to fill in the following info<\/span><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bbf4c93 elementor-widget elementor-widget-elementskit-contact-form7\" data-id=\"bbf4c93\" data-element_type=\"widget\" data-widget_type=\"elementskit-contact-form7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"ekit-wid-con\" ><div class=\"ekit-form\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f646-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"646\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/zh\/wp-json\/wp\/v2\/pages\/96#wpcf7-f646-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/zh\/wp-json\/wp\/v2\/pages\/96#wpcf7-f646-o1\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"646\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f646-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label> \u4e2d\u6587&\u82f1\u6587\u59d3\u540d Full Name (eg.\u56fd\u5b89\u5802 GUO AN TANG)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u751f\u65e5 DOB<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"dateofbirth\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"dateofbirth\" \/><\/span><\/label>\n<\/p>\n<p><label> \u8054\u7cfb\u53f7\u7801 Phone Number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PhoneNumber\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"tel\" name=\"PhoneNumber\" \/><\/span><\/label>\n<\/p>\n<p><label> \u7535\u90ae Email<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u4ece\u4e8b\u884c\u4e1a Occupation<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-occupation\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u8eab\u4efd\u8bc1 NRIC\/FIN<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-NRIC\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-NRIC\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u5730\u5740 Address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Address\" \/><\/span> <\/label>\n<\/p>\n<p><label> \u672c\u4eba\u60a3\u6709\/\u66fe\u60a3\u6709\u4ee5\u4e0b\u75be\u75c5\uff0c\u6216\u4ee5\u4e0b\u60c5\u51b5\u3002I have or ever had any of the following :<br \/>\n<\/label>\n<\/p>\n<p><label> Heart Disease \u5fc3\u810f\u75c5<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"HeartDisease\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"HeartDisease\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"HeartDisease\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"HeartDisease\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Diabetes \u7cd6\u5c3f\u75c5<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Diabetes\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Diabetes\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Diabetes\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Diabetes\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> High Blood Pressure \u9ad8\u8840\u538b<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"HighBloodPressure\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"HighBloodPressure\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"HighBloodPressure\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"HighBloodPressure\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> High Cholesterol \u9ad8\u80c6\u56fa\u9187<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"HighCholesterol\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"HighCholesterol\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"HighCholesterol\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"HighCholesterol\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Hepatitis \u809d\u708e<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Hepatitis\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Hepatitis\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Hepatitis\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Hepatitis\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Cancer \u764c\u75c7<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Cancer\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Cancer\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Cancer\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Cancer\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Sensitive Skin \u76ae\u80a4\u654f\u611f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"SensitiveSkin\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"SensitiveSkin\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"SensitiveSkin\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"SensitiveSkin\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> HIV \/ AIDS \u827e\u6ecb\u75c5<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"HIVAIDS\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"HIVAIDS\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"HIVAIDS\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"HIVAIDS\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Epilepsy \u766b\u75eb<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Epilepsy\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Epilepsy\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Epilepsy\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Epilepsy\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Bleeding Disorders or Tendency \u4e0d\u6b63\u5e38\u51fa\u8840<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"BleedingDisorders\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"BleedingDisorders\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"BleedingDisorders\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"BleedingDisorders\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Cardiac Pacemaker \u5fc3\u810f\u8d77\u640f\u5668<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CardiacPacemaker\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"CardiacPacemaker\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"CardiacPacemaker\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"CardiacPacemaker\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Taking Anti-Coagulants \u6b63\u5728\u670d\u7528\u6297\u51dd\u8840\u5242<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Anti-Coagulants\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Anti-Coagulants\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Anti-Coagulants\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Anti-Coagulants\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Faint During Acupuncture Treatment \u6655\u9488<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"FaintDuringAcupunctureTreatment\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"FaintDuringAcupunctureTreatment\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"FaintDuringAcupunctureTreatment\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"FaintDuringAcupunctureTreatment\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Pregnant\/Postnatal \u6000\u5b55\/\u4ea7\u540e<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"PregnantPostnatal\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"PregnantPostnatal\" value=\"Yes \u6709\" \/><span class=\"wpcf7-list-item-label\">Yes \u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"PregnantPostnatal\" value=\"No \u6ca1\u6709\" \/><span class=\"wpcf7-list-item-label\">No \u6ca1\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"PregnantPostnatal\" value=\"Unsure \u4e0d\u786e\u5b9a\" \/><span class=\"wpcf7-list-item-label\">Unsure \u4e0d\u786e\u5b9a<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Surgery \u624b\u672f<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Surgery\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Surgery\" \/><\/span> <\/label>\n<\/p>\n<p><label> Others \u5176\u5b83<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Others\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Others\" \/><\/span> <\/label>\n<\/p>\n<p>I hereby request and consent to the performance of Acupuncture and other related procedures by registered TCM physician and also tuina etc.service by therapist in this clinic.\u672c\u4eba\u8981\u6c42\u53ca\u540c\u610f\u63a5\u53d7\u8bca\u6240\u5185\u6ce8\u518c\u533b\u5e08\u6240\u65bd\u4e88\u7684\u9488\u7078\u7b49\u76f8\u5173\u4e2d\u533b\u6cbb\u7597\u4ee5\u53ca\u6cbb\u7597\u5e08\u6240\u65bd\u4e88\u7684\u63a8\u62ff\u7b49\u7406\u7597\u670d\u52a1\u3002\n<\/p>\n<p>I understand and am informed that in the performance of acupuncture and\/or other relater procedures, there are some risks to treatment which include, but not limited to, bleeding,bruising, pain, faint, convulsions, burn, stuck or bent needles and any other risks as informed by the Physician.\u672c\u4eba\u7ecf\u533b\u5e08\u89e3\u91ca\u5e76\u4e86\u89e3\u9488\u7078\u53ca\u76f8\u5173\u6cbb\u7597\u65f6\u6709\u53ef\u80fd\u53d1\u751f\u7684\u9884\u540e\u60c5\u51b5\uff0c\u5982\u51fa\u8840\uff0c\u6de4\u8840\uff0c\u75bc\u75db\uff0c\u60ca\u53a5\uff0c\u70eb\u4f24\uff0c\u6ede\u9488\uff0c\u5f2f\u9488\u7b49\u3002\n<\/p>\n<p>I do not expect the Physician\/Therapist to be able to anticipate and explain all possible risks and complications, I wish to rely on the Physician\/Therapist to exercise his\/her judgement during the course of treatment to his\/her best ability.\u672c\u4eba\u4e86\u89e3\u4e0d\u5e94\u671f\u671b\u533b\u5e08\/\u6cbb\u7597\u5e08\u80fd\u9884\u77e5\u5e76\u89e3\u91ca\u6240\u6709\u98ce\u9669\u53ca\u9884\u540e\u60c5\u51b5\u3002\u672c\u4eba\u5e0c\u671b\u4f9d\u8d56\u533b\u5e08\/\u6cbb\u7597\u5e08\u7684\u7ecf\u9a8c\u4e0e\u5224\u65ad\u5f97\u5230\u9002\u5f53\u7684\u6cbb\u7597\u3002\n<\/p>\n<p>The provision of our Facility; products and services to you are governed by the terms and conditions herein; our Terms of Trade (<a href=\"https:\/\/guoantangtcm.com\/zh\/term-of-trade\/\" target=\"_blank\">https:\/\/guoantangtcm.com\/term-of-trade\/<\/a>); and our Privacy Policy (<a href=\"https:\/\/guoantangtcm.com\/zh\/privacy-policy\/\" target=\"_blank\">https:\/\/guoantangtcm.com\/privacy-policy\/ <\/a>), which form the Agreement between us. Please read the terms and disclaimers contained therein carefully. BY USING OUR FACILITY; AND\/OR ANY OF OUR PRODUCTS AND SERVICES, YOU ARE AGREEING TO ALL THE TERMS CONTAINED IN THE AGREEMENT.\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-124\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-124\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree to the terms & conditions above.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Your Signature<br \/>\n[signature* signature-505] <\/label>\n<\/p>\n<p><label> Date<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-430\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-430\" \/><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"zh\"\/><\/form>\n<\/div>\n<\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-0920df3\" data-id=\"0920df3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>TCM SG Health Declaration&amp;Consent Form&nbsp; \u56fd\u5b89\u5802\u5065\u5eb7\u58f0\u660e&amp;\u6cbb\u7597\u540c\u610f\u4e66 Please take a minute to fill in the following info \u4e2d\u6587&amp;\u82f1\u6587\u59d3\u540d Full Name (eg.\u56fd\u5b89\u5802 GUO AN TANG) \u751f\u65e5 DOB \u8054\u7cfb\u53f7\u7801 Phone Number \u7535\u90ae Email \u4ece\u4e8b\u884c\u4e1a Occupation \u8eab\u4efd\u8bc1 NRIC\/FIN Address \u672c\u4eba\u60a3\u6709\/\u66fe\u60a3\u6709\u4ee5\u4e0b\u75be\u75c5\uff0c\u6216\u4ee5\u4e0b\u60c5\u51b5\u3002I have or ever had any of the following : Heart Disease \u5fc3\u810f\u75c5 Yes \u6709No \u6ca1\u6709Unsure \u4e0d\u786e\u5b9a Diabetes \u7cd6\u5c3f\u75c5 Yes [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-96","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.2 - 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