KIWI Serenity Limited

Important Notice: This questionnaire is for travel coordination purposes only and does not constitute medical assessment, diagnosis, or medical advice.

重要声明：本问卷仅用于医疗旅行与行程协调之目的，不构成任何医疗评估、诊断或医疗建议。

Note:This questionnaire is bilingual. Please fill in all information in English.

请注意:本问卷为中英文对照，请用英文填写所有信息。填写后将转交诊所进行医生预评估。

Note:Please fill in English. Your information may be shared with your selected third-party provider for scheduling and suitability screening conducted by that provider. KIWI Serenity Limited does not provide medical advice or assessments. All fields marked with * are required.

请注意: 请使用英文填写，本问卷信息可能转交所选第三方服务方用于预约安排与适配性筛查。KIWI Serenity Limited不提供任何医疗评估或建议。所有带 * 的为必填项。