fbpx

Hälsodeklaration

Your name(Obligatoriskt)
Today's date(Obligatoriskt)
Do you smoke?(Obligatoriskt)
Have you - or have you had any heart or cardiovascular diseases? (For example high blood pressure)(Obligatoriskt)
Do you have high blood pressure?(Obligatoriskt)
Do you have any other diseases? (For example diabetes or epilepsy)(Obligatoriskt)
Do you take any medication? (For example blood thinning medicine)(Obligatoriskt)
Are you allergic to any medication? (for example antibiotics)(Obligatoriskt)
Do you have a blood infection? (for example Hepatitis B/C or HIV)(Obligatoriskt)

Upload photos of you in different angles

See examples above each uploading option

Example photos
Max filstorlek: 10 MB.
Max filstorlek: 10 MB.
Example photos
Max filstorlek: 10 MB.
Max filstorlek: 10 MB.
Example photos
Max filstorlek: 10 MB.
Max filstorlek: 10 MB.
Example photos
Max filstorlek: 10 MB.
Max filstorlek: 10 MB.
Consent(Obligatoriskt)