Cholesterol Survey

Cholesterol

There are only a few steps to get started.

    Choose your Location

    What is your date of birth?

    Have you taken any medicine before to lower your cholesterol?

    Tell us more

    Enter your most recent blood pressure reading from the previous six months

    Are/Do you …?

    Have you been diagnosed with high blood pressure or diabetes?

    Tell us more

    Do you have a family history of high cholesterol?

    Do you smoke?

    Smoking raises the risk of heart disease.

    Have you had a history of heart disease or attack peripheral artery or vascular disease?

    Tell us more

    Do you experience any of the following symptoms?

    Do you have a history of hypothyroidism (low thyroid)?

    Do you currently drink alcohol or alcoholic beverages?

    Are you allergic to any medicines? Milk protein? Aspirin, NSAIDs, or phenylalanine?

    Please list your drug allergies and what happens when you use that drug.

    Do you take other medication(s) or have any other medical conditions?

    Include vitamins, herbs, and over-the-counter products, like pain relievers and sleep aids and WHY you are taking them.

    In order for us to provide you with the best care, please let us know what medications you take and what conditions you have.

    Do you have any of these conditions?

    Anything else you would like us to know?

    ell us about any concerns or questions you have for the medical team.

    How would you like to pay?

    upload emirates insurance details (if available) Upload a Photo of your Emirates ID Upload Front Upload Back

    Billing and delivery details

    Google Map: (Please Share your Google Map Link) Delivery Location Neighborhood/Area: Street Name/No: Address Details:

    Personal Details

    Title: First Name: Last Name: Mobile Number: E-mail:

    Confirm Request and Agree to Terms