Welcome to the VIOS Clinic Registration
This form will create a user profile to help us process your booking application. Data provided in this form will not be shared with any third party entity not affiliated with ViOS, Inc or its processes. You may request to delete a completed form at your convenience by contacting
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Profile Name (You may provide an alias or only your first name)
Are you inquiring about a pre-diagnosed health issue related to the field of opthalmology? Please confirm you are seeking a consult with Dr. Sheikh
During your scheduled Zoom meeting, Dr. Sheikh will give you an expert second opinion, lifestyle counselling or non-surgical consultation for your health/medical needs. Do you agree?
Dr. Sheikh will NOT be providing a primary diagnosis (without a prior physical exam) for your health concerns, complaints or surgical needs.
Dr. Sheikh will NOT provide you any form of online prescription. You may discuss any treatment plan or prior prescriptions given to you by your local surgeon or doctor.
Is this booking for yourself, or on behalf of someone else?
For someone else
Which city will you be joining from? eg. London
If you would like to discuss your health records (reports, scans, tests, prescriptions etc), please scan them, save it on your desktop & you may screen share them with your Provider
I agree to the terms and conditions set by ViOS, Inc.
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