Health Questionnaire for HK Digestive Health Centre
Please fill out the below information as completely as possible. If you need help, please feel free to call us at 3705 3599 so we may assist you. The survey will take you approximately 10-15 minutes to fill out. If you do not know the answers to some questions you may skip them.

After you fill out and submit the Questionnaire, we will contact you within two business days.

Family Name or Surname *
Your answer
First Name *
Your answer
Chinese name (if applicable)
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
Ethnicity
Your answer
Telephone number *
Your answer
Email *
Your answer
What is the best way to contact you? *
HKID (or other ID card)
Your answer
Address
Your answer
Height
Your answer
Weight
Your answer
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