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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

Male

Female

Yes

No

Yes

No

Yes

No

Yes

No

In-Person

Online/Virtual

Yes

No

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About Us

Help us match you to the right medical consultant

What type of specialist are you looking for?

What is your gender identity?

Do you have any pre-existing medical conditions

Are you currently taking any medication?

Do you have any known allergies ?

Have you undergone any surgeries in the past ?

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

What is the reason for consultation?

What is your preferred consultation type ?

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

Do you have health insurance?

Insurance Provider ?

Insurance Provider Policy Number?

Additional Comments?

Which country are you in?

Which language do you prefer?

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