申请约诊-河南赛思口腔医院

请问您是否曾在医院接受过医疗服务？

Have you ever received medical services in our hospital?

是 Yes 否 No 不确定 Not sure

请填写您的姓名

Please enter your name

请选择您的性别

Please choose your gender

男 Male 女 Female

请问您的出生日期？

What is your date of birth?

请填写您的电话号码

What is your phone number?

请填写您的邮箱

Please enter your email address

请问您的联系地址？详细了解我们现在向您询问地址的原因。

What is your contact address? Learn more about why we are asking you for your address now.

现在获取您的地址有助于我们的后续通话。
现在问询您的地址，可以在进行约诊电话时节约时间。
这样，我们在通话时就可以把更多时间用于讨论您的医疗状况和护理规划。

Getting your address now will help us with subsequent calls. Asking for your address now will save your time while we contacting you. This allows us to spend more time discussing your medical condition and treatment plan during the call

接下来，请说明您的主要病症。
是什么医疗状况促使您申请约诊？我们会请您进行描述。
如果还有其他医疗状况，您也将有机会告诉我们。

Next, please describe your main symptoms. What medical condition insisted you to request an appointment? We'll ask you to describe it. If you have any other medical conditions, you can also tell us.

请问您最主要的口腔问题或症状是什么？我们可以从中了解到如何为您提供帮助。

What is your main oral symptom? We will learn how we can provide help.

还有任何其他口腔健康问题您想要提出来的吗？我们可以从中了解到如何为您提供服务。

Are there any other oral health issues you'd like to bring up? We can learn how to serve you better.

请问您来医院，是否经他人介绍/医生转诊？

Have you been referred to our hospital by a doctor/others?

是（他人介绍） Yes (By others) 是（医生转诊） Yes (By doctors)

否 No

您的申请即将完成，让我们最后再问几个问题。
我们将询问您有没有任何首选地点。如果还有我们应该了解的其他信息，您也将有机会告诉我们。
您提交申请后，我们将在一个工作日内与您联系。

Your application is almost complete, so let's wrap up with a few more questions.
We will ask if you have any preferred locations. If there is any other information we should know, you can also tell us.
After you submit your application, we will contact you within one business day.

请问您是否有首选的院区？如果没有也没有关系，我们可以在之后详细讨论这些院区地点。

Do you have any preferred hospital area? If not, we can discuss the locations of these hospitals in detail later.

没有首选项 No 东明路院区 Dongming Institution

原盛国际院区 Yuansheng Institution 普罗旺世院区 Puluowangshi Institution

您希望何时可以到访我们的医疗机构？

When would you like to visit our medical institution?

24小时内 Within 24 hours 48小时内 Within 48 hours

72小时内 Within 72 hours 1周内 Within 1 week 不确定 Not sure

请问您还有什么需求？例如指定的医生或个性化的需求。

Is there any other needs you would like to provide? For instance, appointing a designated doctor or personalized needs.

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