HealthLink

Health & medicine profile

Fill in the details for yourself or a family member. Print a medicine card for the doctor, or send it to us for a free, personalised diet plan by email.

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Patient details

The person this health record is for.

Full name *Please enter the patient’s name Relation to you

Age *Enter an age from 0 to 120 Gender Blood group

Weight (kg) Height (cm)

Health issues

Each condition, since when, and who diagnosed it.

Current medicines

Copy the name exactly as printed on the box or prescription. Include vitamins.

Side effects noticed

Any reaction after a medicine: nausea, dizziness, weakness, acidity, appetite loss, swelling…

Serious reaction, such as trouble breathing, swelling of the face or chest pain? Don’t wait for this form: call 1122 or go to the nearest hospital.

Food & lifestyle

Helps us make a diet plan that fits.

Food habits Daily activity

Allergies (food or medicine) Foods avoided or disliked

Anything else the doctor or diet planner should know

Send for a free diet plan

We reply by email, usually within two to three days.

Your name *Please enter your name Your email *Please enter a valid email so we can reply

HealthLink gives general information only. It is not a diagnosis or treatment. Always check diet or medicine changes with a qualified doctor.

Health & medicine profile

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