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避孕药申请-您的名字
Your Name 

You will be contacted via email regarding payment details once our doctors have approved your prescription application.
Please do not share this document with others for your privacy.

在医生审阅问卷及批准处方后,我们的工作人员会以邮件方式通知您付费。本表格在平常情况下可以替代医生电话或视频就诊。本文档含有您个人隐私信息,不要发给任何人。

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