Booking Form 預訂表格
Tell us more about you so we can get back to you with more info. 告訴我們更多關於您的信息，以便我們回覆您並提供更多信息。
About You
關於你自己
First Name
Last Name
Email
Phone Number
Birth Partner’s Name
Birth Partner’s Phone Number
Address
Your Birth
關於您的分娩
Expected delivery date
How are you planning to give birth? 你打算如何生孩子？
Natural Birth 自然分娩
C-Section 剖腹產
Undecided 未定
Birth location (select one) 出生地點（選擇一項)
Canossa Hospital (Caritas) 嘉諾撒醫院（明愛）
Evangel Hospital 播道醫院
Gleneagles Hong Kong Hospital 港怡醫院
Hong Kong Adventist Hospital - Stubbs Road 香港港安醫院–司徒拔道
Hong Kong Adventist Hospital - Tsuen Wan 香港港安醫院–荃灣
Hong Kong Baptist Hospital 香港浸信會醫院
Hong Kong Sanatorium & Hospital 養和醫院
Matilda International Hospital 明德國際醫院
Precious Blood Hospital (Caritas) 寶血醫院(明愛)
St. Paul's Hospital 聖保祿醫院
St. Teresa's Hospital 聖德肋撒醫院
Union Hospital 仁安醫院
Other 其他
Your Medical History 您的病史
These questions are designed to look for key contraindications for placenta encapsulation. The results of the survey is confidential. 這些問題旨在尋找胎盤包裹的關鍵禁忌症。 調查結果是保密的。
Have you ever tested positive for any of the following conditions (tick all that apply): 您是否曾在以下任何情況下檢測出陽性（勾選所有適用項)：
HIV/AIDS 艾滋病毒/艾滋病
Hepatitis B 乙型肝炎
Hepatitis C 丙型肝炎
Genital Herpes 生殖器皰疹
Group Strep B 鏈球菌B組
None Of the Above 沒有
Have you ever had a blood transfusion? 你曾經輸過血嗎？
Yes 有
No 沒有
Do you have any allergies? 你有任何過敏症吗？
Yes 有
No 沒有
Are you on any medication? 你有吃藥嗎？
Yes 有
No 沒有
Do you smoke? 你抽煙嗎？
Yes 有
No 沒有
Please upload your Hepatitis B report if you have it. 如果有，請上傳您的乙型肝炎報告。
Select a File
Additional relevant information about your pregnancy and health status
Your Order
您的訂單
Please Let us know what product(s) you are interested in. 請讓我們知道您對什麼產品感興趣。
Placenta Encapsulated Pills 胎盤素丸 $4850
Placenta Tincture 胎盤酊劑 $1580
Both 兩者都想要
Terms & Conditions 條款和條件
Please read our Terms & Conditions before completing your booking 請在完成預訂前閱讀我們的條款和條件 https://www.treeoflifeplacenta.info/terms-and-condition
I agree to the terms & conditions
Submit 提交
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