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| Title 「TAKATA Dental clinic診療相談」 | |
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| @ | If someone recommend our clinic, his/her name |
| A | Your name |
| B | Gender |
| C | Date of birth |
| D | How old you are |
| E | Address |
| F | TEL number |
| G | Other contact number if you have. |
| H | If you got a serious diseases, the name of the diseases . |
| I | Do you have any clinic you go to now |
| J | If you have medicine that you take regularly, the name of the medicine |
| K | Anything that you want to ask or take counsel with. |
| L | preferred date and time |
| ・ | 1st preference |
| ・ | 2nd preference |
| ・ | 3rd preference |
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Because we have to adjust our schedule, please propose date after 2 weeks. Please note that we are unable to accommodate reservations made within two weeks, after 5pm within a month, or on Saturdays within a month. |
(Explatnation) Once you clic the email adress, mail soft in your PC will open the formed email automatically. Please make email as formed. If you want to make email without such a email soft please make email by your hand. But please do not delete the email title. We cannot tell them from malicious mail. | |
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