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Health declaration

Please fill out the following form.

Date of birth
Month
Day
Year
Have you been hospitalized in the last 12 months?
No
Yes
Are you suffering from a medical condition, illness or injury?
No
Yes
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Guan Shin Clinic Jiayi Clinic Guan Shin Pharmacy

Guan Shin Medical Examination Center

佳藝診所  益嘉藥局

Address: 150 2-1 -2 Liming East Road

Address: 388, Section 2, Fengshi Road, Fengyuan District

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