申請表
Application Form

自然免疫平衡療法【根治】呼吸系統疾病
Taoist Natural Immune Equilibrium Therapy: A True Cure for Respiratory Diseases

基本信息Basic Information

昵稱Nickname*

年齡Age*

性別Gender*

手機號Phone Number*

國家（選填）Country (Optional)

省份（選填）Province (Optional)

城市（選填）City (Optional)

郵箱（選填）Email (Optional)

呼吸系統疾病情況Disease Information

呼吸系統疾病確診年數Years Since Diagnosis*

主要用藥Main Medication*

目前每月呼吸系統疾病治療的自費費用（元）Monthly Out-of-Pocket Medical Expenses (CNY)*

目前主要症狀Current Main Symptoms*

其他信息Other Information

其他疾病和用藥Other Diseases and Medications*

提交後請等待頁面回應，添加助理微信好友，備註手機4位尾號After submission, please wait for the page response, then add the assistant's WeChat with the last 4 digits of your phone number as note

* 表示必填項* indicates required field

申請表Application Form

自然免疫平衡療法【根治】呼吸系統疾病Taoist Natural Immune Equilibrium Therapy: A True Cure for Respiratory Diseases

申請表
Application Form

自然免疫平衡療法【根治】呼吸系統疾病
Taoist Natural Immune Equilibrium Therapy: A True Cure for Respiratory Diseases