questions.

What’s your_________
Could tell me your __________
May I know your __________

Do you _________________
Are you __________________
 Example Of the admission Card!
Surname : - may I know your surname ?
First name: what’s your first name? ( again)
- Cold you spell your first name?
Address : Where do you live?
- do you live in Tuban? ( guess)
Phone No: do you have a telp. Number?
- Could you repeat it again?
Date of birth: When were you born?
What’s your date of birth?
Civil state : are you married?
Occupation : What’s your occupation?
Do you have a Job?
Religion : May I know your religion?
G.P : Could you tell me your G.P?
Family : Dou have any immediate

family with illness history?,

heart attack, stroke or
something else?