Update My Medical Profile

My Medical Profile

Update your medical information

Submit info and medical documents.

Full Name *

Email *

Mobile Phone # *

Address *

Date of Birth *

ID/DP/PP# *

Upload a picture of your ID/DP/PP *

1. Please tell us in as much detail as possible about your current concern ( duration, severity, things that may improve and worsen your condition, other associated symptoms)

2. Have you been diagnosed with any medical conditions ( eg asthma, diabetes/high blood sugar, hypertension/high blood pressure, cardiac/heart issues, stroke, dementia, kidney disease, seizure/epilepsy)

3. Have you been hospitalized? If so, please indicate the reason for hospitalization, location and duration of your stay and any follow up care recommendations.

4. Have you had any surgeries/operations before? If yes please state what type of surgery and year this took place.

5. Do you have any known allergies? If yes please state which medication/food/substance.

6. Are you currently taking any medication, supplements or herbal remedies? If yes, please list them.

7. Do you smoke? If yes please state the approximate number of years and number of cigarettes/packs per day.

8. Are you an ex smoker? If yes, please state the year you last smoked, the approximate number of years and number of cigarettes/packs per day.

9. Do you drink alcohol? If yes please state the quantity and type of drinks you consume in a given month.

10. Is there a family history of illnesses like diabetes/heart disease/cancer? If yes please give information on the type of illness and relative affected.

11. Is your immunization record up to date? If not, which vaccine is outstanding? (Please scan and upload immunization card in the file cabinet below)

12. Finally, please upload any supporting documents to your personal secure portal for example previous discharge summaries, CT or X-ray reports, blood investigations within the last year. (This information will be shared with the physician you will be seeing.)

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