Patient Registration

Create your account to access AI-powered health assessments and consultations

First Name *

Last Name *

Date of Birth *

Gender *

Email Address *

This will be your login username

Phone Number *

Address

Country

City

State / Province

Postal / Zip Code

Password *

Minimum 8 characters

Confirm Password *

Emergency Contact Name

Emergency Contact Phone

Relationship

I accept the Terms & Conditions

I accept the Privacy Policy

I confirm that I am 18 years of age or older.

I agree to receive health tips, updates, and promotional emails (Optional)

I consent to the processing of my personal health data for medical assessment purposes *

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