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General Consultation Survey

General Consultation

There are only a few steps to get started.

    Choose your Location

    What is your date of birth?

    Are you allergic to any medicine?

    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?

    Please include any antibiotics, name of birth control, as well as any over-the-counter and herbal dietary or potassium supplements.

    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?

    Please specify

    Anything else you would like us to know?

    Tell 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