Home / Patient forms
Before your visit
Fill this before you come.
Ten minutes at home saves twenty in the consulting room — and means the visit begins with your questions instead of your date of birth. Your answers go straight to the clinic and into your file.
Free to everyone
Take this to your family,
your village, your friends.
Everything on this website is free to read, to print and to pass on. Ask for the booklet on WhatsApp, or put your name down for मधुसंदेश and the camp notices.
या संकेतस्थळावरील सर्व माहिती मोफत आहे. ती वाचा, छापा आणि इतरांना द्या.
Your name goes into a WhatsApp message that you send, from your own phone. Nothing is stored on this website. Tell the clinic to stop at any time and it stops. No WhatsApp? Write to uniteddiabetes@gmail.com.
Two forms
Which one is
for you?
The first visit needs a full history. After that, a short note on what has changed is enough.
Form one
New patient — history form
Please fill this before your visit. It lets the consultation start with your questions instead of the basics, and it means nothing important is forgotten while you are in the room. It takes about ten minutes. Nothing here replaces the consultation.
Form two
Appointment request
A short form so your file is ready before you arrive. If you do not know your Clinic ID, leave it blank and give your mobile number instead.
If the form will not send
Then bring it on paper.
Press Print instead and fill it by hand. A form filled at the kitchen table the night before is worth just as much as one sent online — more, sometimes, because there is time to look up the old reports.
Do not delay a visit because the form is not done. Come, and fill it at the clinic.