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Full Name*
Visit Type* Re-visitFirst Visit
Clinic ID （If you alredy have）
Gender* FemaleMaleOther
Age*
Telephone
E-mail*
Inquiry item* Thread LiftStainFreckleWrinklesSagginessAcneAcne ScarsPore"Mole/WartsRuddy FaceHair RemovalVitamin DripOthers
For detailed information and inquiries about your preferences
First Preferred Booking Date* Preferred Booking Time 10:00~12:0012:00~14:0014:00~16:0016:00~18:30(Available only on Weekday)
Second Preferred Booking Date Preferred Booking Time 10:00~12:0012:00~14:0014:00~16:0016:00~18:30(Available only on Weekday)
Third Preferred Booking Date&Time Preferred Booking Time 10:00~12:0012:00~14:0014:00~16:0016:00~18:30(Available only on Weekday)
Treatment Preference* Counseling onlyCounseling + TreatmentCounseling first, and considering treatment on the same day
