email
admin@regeneratia.com
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Full Name
!
person
person
Identity No
!
card_membership
Gender
person
MALE
FEMALE
Birthdate
!
date_range
Phone Number (Whatsapp)
!
phone
Email
!
email
Appointment Date
!
date_range
Department
Aesthetic
Wellness
Therapy
Sport Medicine
Area
Jakarta
Banten
Batam
Consultation Hour
access_time
< 13.00
> 13.00
REGISTRASI
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