Patient Information and Medical History
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Personal Details:
Medical Questionnaire
Do you suffer from any medical condition?
Do you take any medication for any condition?
Do you have a heart condition?
Are you allergic to anything you know of?
Are you seeing the doctor for anything?
Are you HIV+ve ?
Have you ever had Hepatitis B or C?
Do you suffer from Haemophilia?
How Did You Hear About Us?
Social Media
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