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Evercare In-Home Health Test Booking Form
上門健康檢查服務預約表格

Thank you for contacting Evercare, please find our service details and price along with our Terms and Conditions shown here:  https://www.yourevercare.com/service-agreement

Please provide your information and service requests below so that we can contact you with further details. Thank you.

親愛的 客戶, 感謝您早前與我們聯繫，查詢晨曦居家護理服務，以下涵蓋我們的收費表和服務條款。請在我們服務開始配對前細閱服務同意書。https://www.yourevercare.com/zh-tw/service-agreement

請提供以下資料，讓我們可以更清楚了解您的需要。 我們的護理專家將會在一日內聯絡你以確認服務選擇和日期。

Personal Details 個人資料

Eg: A123456(7)
Date of Birth 出生日期*
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Your lab report will be sent to you via this email. 
我們會透過此電郵地址發送您的化驗報告。

We will contact you to confirm your booking details.
我們將會聯絡您以確認服務細節。

Service Booking 預約服務

Select Lab Test Option(s) 選擇以下化驗項目:*
Can select more than one 可選擇多項

For STD Tests: Please note that female subject must not be on their period or pregnant at the time of vaginal sample collection.
For Male Fertility Test: In order to obtain accurate result, avoid seminal emission for at least 3 days prior to collection.

性傳染病檢查： 月經及懷孕期間請勿進行陰道採樣。
男性生育檢查： 在標本採集前3天禁行房事。
In-home Blood Collection Date 上門抽血日期*
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Service Language 服務語言*
Can select more than one 可多選
Which language would you wish to receive communication in? 您希望以哪種語言進行溝通？*

Service Agreement 服務條款

Please read through our service agreement before e-signing your name below:
https://www.yourevercare.com/service-agreement

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，然後在下方簽署：
https://www.yourevercare.com/zh-tw/service-agreement
Please use full name as stated in HKID. By stating your full name here you are agreeing to the terms and conditions as laid out in our service agreement.

請使用香港身份證上的全名。 在此填寫您的全名，即表示您同意我們服務協議中規定的條款和條件。

Remarks 注意事項:

  • Customers must present their identity cards on the appointment day. 客戶必須於檢測當天出示身份證明文件以確認身份

  • The test is for reference only, and is not suitable for diagnostic and/or treatment use. 此測試可作參考，並不適用於診斷或/及治療之用

  • Patients are not required to fast prior to blood test. 抽血前無需禁食

  • Tests will be processed at Precious Blood Hospital (Caritas) - Clinical Pathology Laboratory; which is a HOKLAS accredited lab. 化驗將在寶血醫院 (明愛) - 臨床醫學化驗部進行；這是一個 HOKLAS 認可的實驗所

  • The cost of the test does not include a doctor's consultation, patients who wish to obtain a diagnosis or interpretation after receiving the lab results should consult a medical professional on their own. 化驗價格不包括醫生諮詢費。如果在收到化驗結果後希望獲得診斷或見解，應自行諮詢醫療專業人士