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Appointment Booking
Name :
Age:
Phone:
National ID:
Physician:
E-mail:
- Gender
Male
Female
Child
- Booking Type
Normal Booking
Home Visit
- Booking Date
- Which Branch
Tanta
Mehalla
What are pathological symptoms experienced by the patient?
- fasting
Yes
No
- Number of hours of fasting:
- Are you take the treatment for sugar?
Yes
No
- Treatment Name:
- Do you take treatment of blood thinners?
Yes
No
- Treatment Name:
- Do you take treatment of glands?
Yes
No
- Treatment Name:
- Do you take an antibiotic?
Yes
No
- Treatment Name:
- Have you ever blood transfusion?
Yes
No
- For women Is there a pregnancy?
Yes
No
- For women in the case of hormone tests and pregnancy tests
- What is the deadline LMP:
- Does ovulation stimulants taken?
Yes
No
- In the case of measuring the quantity of the drug in the blood?
Yes
No
- Have you ever analysis by our labs?
Yes
No
- What are the required analyzes?