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Rujak Petis Feedback Dari Puskesmas Padangan

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rujak petis FEEDBACK DARI PUSKESMAS PADANGAN

This form is for collecting feedback from Puskesmas Padangan about rujak petis.

Page 1

Please answer the following questions about rujak petis.

Email*

What is your name?*

What is your age?*

What do you like about rujak petis?*

What ingredients do you pref...*

Pineapple

Mango

Cucumber

Papaya

How often do you eat rujak petis?*

Everyday

Once a week

Once a month

Rarely

Where do you usually buy rujak petis?*

Please upload a photo of you...*

Drop a file here or click the button below to load the file

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Max Combine file size: 10MB

Description:Get feedback from Puskesmas Padangan on your rujak petis recipe. Improve your dish with expert advice from healthcare professionals. Book an appointment now!

Looking for feedback on your rujak petis recipe? Look no further than Puskesmas Padangan! Our healthcare professionals are available to provide expert advice on how to improve your dish. Book an appointment now and take your rujak petis to the next level!

Patient Name*

Patient Age*

Gender*

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Patient Age*

Gender*

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Date of Birth*

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Patient Name*

Patient ID*

Date of Discharge*

Select date

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What time do you usually wake up?*

Do you have trouble falling asleep?*

Yes

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What is your date of birth?*

Select date

What is your gender?*

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Gender*

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Gender*

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What is your gender?*

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Other

What is your highest level of education?*

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