Do You Smoke?

How many times you smoke?




Do you drink alcohol?

Quantity

If Female-any kids?

Age of kids
How were the kids delivered?
Do you suffer from any morbid condition like-?



Have you suffered from any of the conditions recently as mentioned below-?



Have you received any blood transfusion within last 3 months?
Please specify
Have you received any vaccination within last 3 months?
Please specify
Have you been prescribed anti-coagulants?
Please specify
Do you take any medication?
What are the dosages?
Are you allergic to any medicines or substance?
Please specify
Any other important medical details that you would want to share?
Travcure