If you have persistent chest pain and are unsure if it is due to heartburn, seek emergency medical attention.
—Please choose an option—Abu DhabiAl AinDubaiSharjahAjman
Burning sensation in the back of your throatBitter, acid taste in your mouthUncomfortable feeling from your stomach to your mouth or to the back of your throatOther
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After mealsAt the nightWhen laying down shortly after eatingOther
Drinking coffeeEating fatty or spicy foodsSmokingPregnancyFeeling stress and anxietyOtherNone
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Once a weekTwice a weekMore than half of the daysEvery dayOther
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YesNoAre you allergic to any medicine? YesNo
Please list your drug allergies and what happens when you use that drug.
Please include any antibiotics, name of birth control, as well as any over-the-counter and herbal dietary or potassium supplements.
YesNoIn order for us to provide you with the best care, please let us know what medications you take and what conditions you have.
NonePregnant or planning to become pregnantBreastfeedingHistory of kidney problemsHistory of liver problemsA diagnosed immune disorderOther
Tell us about any concerns or questions you have for the medical team.
Out of pocketInsurance
upload emirates insurance details (if available)
Upload a Photo of your Emirates ID
Google MapDelivery Location
Google Map: (Please Share your Google Map Link)
First Name: Last Name:
Date of Birth:
Mobile Number: E-mail:
After you submit your request, a licensed medical provider will review your information. You will be notified by email/contact number when that provider has reviewed your request and, if appropriate, made care recommendations.