Check-up Guide

Internet Reservation
Name	(Family Name / Given Name / Middle Name)
Gender	Male Female
Birthday (D,M,Y)	(ex)14 / Apr / 2006
Nationality
Passport Nember
Address in Korea
Permament Address
Contact Nember (in Korea)	Telephone Nember
	Mobile Nember
	E-mail
	Fax Nember
Emergency Contact	Name
	Relationship to the Patient
	E-mail
	Telephone Nember
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