Medical Intake Form Surname: * Middle Name: Given Name (s): * Your Preferred Way of Contacting (Please Choose One) TelWhatsappWechat Email: * HKID Card or Passport no: * Date of Birth: * Occupation (Patient): Address: * Diagnosis: Date of Diagnosis: Supervising Doctor (if any): Supplement Intake (if any): Medical Diagnostic Forms: MRI, CT, Blood tests, etc .doc, .pdf, jpeg, .txt, .png only Each File Should be less than 2mb (for file bigger then 2MB , you can contact us directly via email: cancercare@lifeclinic.com.hk) Additional Comments:
.doc, .pdf, jpeg, .txt, .png only Each File Should be less than 2mb (for file bigger then 2MB , you can contact us directly via email: cancercare@lifeclinic.com.hk)