Patient Registration
Create your DDEY Patient Account
Service Selection
Consultation Service
*
Select Service
General Medical Consultation
Doctor Dey Consultation
Personal Information
Email
*
Full Name
*
Age
*
Address
*
WhatsApp Phone Number (with country code)
*
Marital Status
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Married
Single
Divorced
Separated
Other
Religion
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Christianity
Islam
Atheist
Other
Physical Information
Height (meters)
*
Weight (kg)
*
Medical Information
Current Chronic Medical Conditions
*
Hypertension
Diabetes
Dyslipidaemias
Obesity
Dementia
Depression
Anxiety
Addiction
Others
How long have you been diagnosed with this condition?
*
Are you on regular (periodic) medical check-up for your condition?
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Yes
No
Sometimes
Have you ever suffered a complication requiring hospitalization?
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Yes
No
Disability Information
Do you have any physical disability?
Yes
No
If any disability, kindly specify
Select (if applicable)
Blind
Deaf
Partial paralysis
On wheelchair
Bed ridden
Dumb
Other
Health Motivation
Are you motivated to get better via lifestyle medicine options?
*
Rate your motivation from 1 (Not motivated) to 10 (Very motivated)
1
2
3
4
5
6
7
8
9
10
Account Credentials
Password
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Confirm Password
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