What’s your name? 2. Apakah anda sudah menikah? Are you married? 3. Dimana alamat anda? What’s your address? 4. Apakah anda membawa surat rujukan dari dokter umum? Do you bring a referral letter from a general practitioner? 5. Pekerjaan anda? What’s your occupation? 6. Siapa kerabat dekat yang bisa kami hubungi? Who’s your nearest relative to contact? 7. Tanggal lahir anda? Your date of birth?