17/10/2021
My Health History Record
Name
Gender/Sexe
Take a picture/Photo

Select File...
Pic photo orientation will be automatically rearrange before printing / simply set your phone to auto-rotate
DOB
 dd/mm/yyyy
Doctors Details
Emergency Contact
Email
Relationship
Medical Records if any
Blood Group
Medications
Hospital/Clinique
Allergies
Others Health History
Other Info
Language
Price/Prix
Referral Code
Click to create your KeyPass
Enter any 4 digits pin code
Submit & Pay Now