Patient Details Confirm your identity so we can pull up your records. Returning Patient Notice Returning patient? Please provide the same name and email used during your initial consultation so we can locate your records. Full Name Email Address APPROXIMATE DATE OF LAST CONSULTATION country of residence Select Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea North Macedonia Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe WhatsApp / Phone City / State Treating Doctor (if known) Select Dr. Chintan Dalal Dr. Krushal Pabari Not Sure Health Update Tell us how you've been since your last visit CURRENT SYMPTOM SEVERITY VS LAST VISIT 📈 Better than last visit ➡️ About the same 📉 Worse than last visit OVERALL HEALTH SCORE TODAY KEY SYMPTOMS SINCE LAST CONSULTATION ANY NEW DIAGNOSES OR HEALTH EVENTS SINCE LAST CONSULT? MEDICATION CHANGES SINCE LAST CONSULTATION Adherence to the prescribed protocol? ✅ Fully followed ⚠️ Mostly followed, some gaps 🔄 Partially followed ❌ Not followed / stopped Reason for any non-adherence (if applicable) Specific questions or agenda for this consultation Recent Blood Work Please share your most recent labs since your last consultation 🔑 Key values for follow-up: We primarily need Vitamin D 25-OH, PTH, Serum Calcium, Urine Ca/Cr ratio, and kidney function. Other values are helpful but optional. DATE OF MOST RECENT BLOOD WORK 🧪 VITAMIN D & PTH (MOST IMPORTANT) 25-OH VITAMIN D * PTH * SERUM CALCIUM * URINE CA/CR RATIO (SPOT) * SERUM CREATININE * OTHER RECENT LABS (OPTIONAL) ANY OTHER LABS DONE SINCE LAST VISIT? Proceed to payment
