BSH Diabetic Care Center
Full Name
*
Mobile Number
*
Date Of Birth
*
CPR Number
*
Nationality
*
Gender
*
Male
Female
Rather not say
Are you diagnosed with Diabetes ?
*
Yes
No
if yes, please mention the type of Diabetes
Type 1
Type 2
Date of Diagnosis
Insulin usage
Yes
No
Current Medication
Blood glucose monitoring frequencies
Daily
Weekly
Monthly
Never
From where you heard about BSH Diabetes Care Center?
Instagram
Facebook
LinkedIn
Whatsapp
In-hospital Ad
Flyers
Friends / Family
Newspaper
Other
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Speak with our Contact Center for assistance
Helpline:
+973-17812222
Helpline:
Request an Appointment
