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姓
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名
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性別
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男
女
電郵地址
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電話 (請註明國際區號 852/853)
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年齡組
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青少年 (12-18歲)
成人 (18歲以上)
兒童 (6-11歲)
牙齒問題
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前排牙齒擁擠
咬合過深
倒及
錯咬/ 反咬合
牙縫過大
開咬
齒列擠擁
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