Personal Information Collection Statement

【特別通告致理大眼科視光學診所及社區保健/教學中心應診人士】

理大眼科視光學診所及社區保健/教學中心3月30日開始(直至另行通知)的服務安排如下:

紅磡理大眼科視光學診所
🔸提供有限度服務

葵青荔景社區結合保健中心
🔸暫停服務;其後安排將另行通知

嗇色園-香港理工大學眼科視光學中心 (黃大仙教學中心)
🔸暫停服務;其後安排將另行通知

診所職員將儘快與受影響應診人士聯絡,更改檢查預約日期。特此通知,不便之處,敬希諒解。

【Special Notice to Patients of PolyU Optometry Clinic and Community Optometry Centres】

The services of PolyU Optometry Clinic and Community Optometry Centres from 30 March (until further notice) will be as follows.

PolyU Optometry Clinic on Hunghom Campus
🔸Limited services.

Integrative Community Health Center in Lai King
🔸Services suspended. Further arrangement will be announced.

Sik Sik Yuen – PolyU Optometry Centre (Wong Tai Sin Teaching and Learning Centre)
🔸Services suspended. Further arrangement will be announced.

Our staff will contact the affected patients as soon as possible. We apologize for the inconvenience and appreciate your understanding.

Personal Information Collection Statement

  1. The information collected in this form will be used for the application and liaison in the activities of the School of Optometry, The Hong Kong Polytechnic University. All such information will be destroyed after use.
  2. If you need to check or change your personal information after submitting this form, please contact the Optometry Clinic via email: optclinic.enquiry@polyu.edu.hk
  3. The personal data collected in this form can be owned, transferred and used for audit, liaison, administration and planning purposes by the School of Optometry, The Hong Kong Polytechnic University.

 

收集個人資料聲明

  1. 此表格所收集的資料將用作處理參與香港理工大學眼科視光學院活動的申請及聯絡之用,此等資料將於無需保留時全部銷毀。
  1. 如在遞交此表格後要查閱或更改個人資料,請透過電郵致optclinic.enquiry@polyu.edu.hk 聯絡眼科視光學診所。
  1. 此表格所收集的個人資料,均可由香港理工大學眼科視光學院持有、轉告及用於審核、聯絡、行政及策劃之用途。

I have read and agreed to the content of the above personal data collection statement. / 本人已閱讀及同意上述個人資料收集聲明的內容。

Patient information 應診者資料

Name 姓名 / Patient Name 應診者姓名

(Must be identical to the information on HKID card or Passport 必須與身份證或護照資料相同)

Date of Birth 出生日期

Format: dd-mm-yyyy

Contact person 聯絡人

Contact no. 聯絡電話

Email Address 電郵地址