Hypertension Survey

Hypertension

There are only a few steps to get started.

    Choose your Location

    What is your date of birth?

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

    The 2nd number is the lowest

    Do you remember when you took this blood pressure reading?

    Date

    Select how your reading was done

    Have you taken a hypertensive medicine before?

    What is the drug's name?

    Do you know what your heart rate is?

    What’s your heart rate

    What's your weight (in kilograms)?

    What's your height (cm)?

    Select all that apply to you

    Have you ever taken blood thinners or medicines to regulate your heart rhythm before?

    Do you have any of the following symptoms?

    Can you do at least 150 minutes of moderate physical activity per week?

    Have you ever been diagnosed with any of the following medical problems?

    Do you have any of the following medical conditions?

    Select all that apply to you

    Average number of daily cigarett

    How many cups a day?

    How many cups a day?

    Tell us more

    Are you allergic to any medicines?

    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.

    Please let us know what medications you take and what conditions you have.

    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)

    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:
    Date of Birth:
    Mobile Number: E-mail:

    Confirm Request and Agree to Terms