Patient Registration
It's completely free
First name:
*
Last name:
*
Username(Phone Number):
*
Enter a valid phone number start with 07.....
National ID Number:
National ID must be 16 digits
Date of Birth:
*
Gender:
*
Male
Female
Level of Education:
*
Primary
Secondary
Bachelor Degree
Masters
PhD
Vocation Training
Height:
Enter valid value between 100 and 250
Height must be entered in cm between 100 and 250
Waist(cm):
Waist must be entered in cm
Hip(cm):
Hip must be entered in cm
Exercises History:
*
Less than 2/week
2-3/week
Above 3/week
How long have you been diagnosed with type 2 diabetes:
*
Enter number of years
Please select an hospital:
*
---------
RDA
RMH
CHUK
Regular medication:
Type of medicine:
None
Insulin
Pills
Insulin and Pills
Dosage:
None
Once
Twice
Thrice
Email:
Password:
*
Password confirmation:
*
Enter the same password as before, for verification.
I agree with the
Terms and conditions
.
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