Initial registration form

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Dr. Bothaynah Jubran Clinic

💚 Welcome to Dr. Bothaynah Jubran's Clinic 💚

Step 1 of 4 Personal info

First name *

Last name *

Gender *

Country *

Date of birth *

Email *

Address *

Phone number *

State / region *

Preferred language *

Tell us about your situation *

Medical attachments (optional)

Click to upload files (images, reports, lab results)

jpg, png, pdf, doc — up to 5 files

Voice messages (optional — multiple files)

Upload voice recordings about your condition

mp3, wav, webm, m4a — up to 5 files

Dietary supplements

Medications

Do you have blood tests from the last 6 months? *

Yes No Partially

Health conditions *

Mental health conditions *

Health goal *

Mental wellness goal *

Expectations after the care plan *

Additional information