{!! __("clinic-repair-request-modal.recollection.h5_recollectionRequestForm1") !!}

★{!! __("clinic-repair-request-modal.recollection.p_recollectionRequestForm1_msg") !!}

{!! __("clinic-repair-request-modal.recollection.common.p_desired_datetime") !!}★

{!! __("clinic-repair-request-modal.recollection.common.text_first_choice") !!}★
{!! __("clinic-repair-request-modal.recollection.common.text_second_choice") !!}
{!! __("clinic-repair-request-modal.recollection.common.text_third_choice") !!}
{!! __("clinic-repair-request-modal.recollection.h5_recollectionRequestForm2") !!}

{!! __("clinic-repair-request-modal.recollection.p_recollectionRequestForm2_msg_1") !!}

{!! __("clinic-repair-request-modal.recollection.p_recollectionRequestForm2_msg_2") !!}

{!! __("clinic-repair-request-modal.recollection.common.p_desired_datetime") !!}★

{!! __("clinic-repair-request-modal.recollection.common.text_first_choice") !!}★
{!! __("clinic-repair-request-modal.recollection.text_recollectionRequestForm2_date_1") !!}
{!! __("clinic-repair-request-modal.recollection.text_recollectionRequestForm2_time_1") !!}
{!! __("clinic-repair-request-modal.recollection.common.text_second_choice") !!}
{!! __("clinic-repair-request-modal.recollection.text_recollectionRequestForm2_date_2") !!}
{!! __("clinic-repair-request-modal.recollection.text_recollectionRequestForm2_time_2") !!}
{!! __("clinic-repair-request-modal.recollection.common.text_third_choice") !!}
{!! __("clinic-repair-request-modal.recollection.text_recollectionRequestForm2_not_selected") !!}
{!! __("clinic-repair-request-modal.recollection.text_recollectionRequestForm2_not_selected") !!}
{!! __("clinic-repair-request-modal.recollection.h5_recollectionRequestForm3") !!}
{!! __("clinic-repair-request-modal.recollection.body_text_recollectionRequestForm3_1") !!} {!! __("clinic-repair-request-modal.recollection.body_text_recollectionRequestForm3_2") !!}