IntriHEALTH_RetailCellC_Mobile
IntriHEALTH_RetailCellC_Mobile

    Medical History

    Step 1 of 5

    Step 2 of 5

    Check the conditions that apply to you or to any members of your immediate relatives:

    Asthma

    Cardiac Disease

    Hypertension

    Epilepsy

    Cancer

    Diabetes

    Psychiatric disorder

    Step 3 of 5

    Check the symptoms that you're currently experiencing:

    Chest pain

    Cardiac Disease

    Hematological

    Neurological

    Gastrointestinal

    Weight gain

    Musculoskeletal

    Respiratory

    Cardiovascular

    Lymphatic

    Genitourinary

    Weight loss

    Lymphatic

    Step 4 of 5

    Are you currently taking any medication?

    What is your Gender?

    Do you have any medication allergies?

    Step 5 of 5

    Do you use or do you have history of using tobacco?

    Do you use or do you have history of using illegal drugs?

    How often do you consume alcohol?

    Terms & Conditions