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Help us match you to the right medical consultant

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Please fill out this short questionnaire to provide some background information about you and the issues you'd like to deal with. It would help us match you with the most suitable medical consultant for you. Your answers will also give the consultant a good starting point.

What type of specialist are you looking for?

Psychiatrist

Dentist

Gynaecologist

Family Physician

Paeditricians

Cardiologist

Dermatologist

Ent Doctors

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What is your gender identity?

Male

Female

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Do you have any pre-existing medical conditions

Yes

No

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Are you currently taking any medication?

No

Yes

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Do you have any known allergies ?

Yes

No

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Have you undergone any surgeries in the past ?

Yes

No

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Do you have any family medical history of serious conditions (e.g., heart disease, diabetes)?

Yes

No

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What is the reason for consultation?

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What is your preferred consultation type ?

In-Person

Online/Virtual

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Do you have any specific concerns or questions for the doctor?

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Do you have health insurance?

Yes

No

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Insurance Provider ?

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Insurance Provider Policy Number?

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Additional Comments?

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Which country are you in?

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Which language do you prefer?

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