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健康評估及服務安排
Health Needs Assessment and Care Arrangement



為安排合適的醫護人員，請提供以下資料，讓我們可以更清楚了解您的需要。
Please provide your information and caregiving service requests below 

本人已閱讀及同意

I have read and agreed with the 

顧客服務細則及條款協議

Customer Service Agreement - Terms and Conditions

健康狀況 
Health Condition
Medical Condition 照顧對象健康情況 (Can select more than one 可多選)
服務需求
Required Service(s)
選擇服務 (Can select more than one 可多選)
(Can select more than one 可多選)
你所需要的醫護人員
Required Health Care Personnel
 
Service Days Per Week 每週服務日子
服務對象資料
Patient Information
Patient's Gender 服務對象性別
Preferred Caregiver Gender 護理人員性別要求

聯絡人資料
Contact Person Details
Service Language 服務語言 (Can select more than one 可多選)
How did you hear about us? 如何認識我們？

本人已閱讀及同意

I have read and agreed with the 

Service Agreement 服務條款

Please read through our service agreement before e-signing your name below:


在我們為您開始配對服務前，請先點擊以下連結細閱服務同意書

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*使用家怡康的服務，即表示您同意我們顧客服務細則及條款協議中規定的條款和條件。

顧客服務細則及條款協議

Customer Service Agreement - Terms and Conditions

多謝您的查詢，我們會盡快與你聯絡

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