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0% found this document useful (0 votes)

12 views2 pages

Borang Bekam1

Uploaded by

HarryDKelantani

kj

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Maklumat Pelanggan

1. Maklumat Peribadi
Nama Umur
No. K/P Berat
Pekerjaan Tinggi
No. Tel/H.p
Alamat

Dirujuk Oleh
2. Alahan Seperti kepada makanan, bauan, ubatan dan lain-lain.

3. Masalah Kesihatan
1
2
3
Lain-lain perkara:

4. Pengambilan Ubat Sekarang

5. Pengambilan Herba/Vitamin/suplemen dll

NO. PENDAFTARAN :

Maklumat Rawatan

Tarikh Rawatan Tarikh Rawatan Tarikh Rawatan Tarikh Rawatan

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