個人資料:
聆聽音樂, 多久: _______________________________________________________________
總結健康改善狀況:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
結論:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 我______ 同意所有研究資料作爲OUM大學臨床個案研討及學術發表用途(名字以 ☐原名 或 ☐姓氏稱呼代替),並匯總成冊報告。
簽名 __________________ 日期:________________
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