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Thank you for signing up for PB Challenge!

We are so happy to see you here. For our doctors to know you better, please kindly complete the questions below.

Be assured that all the information you input is for our doctors to understand your health and medical conditions, and it will not be used for any other purposes. 

(Example: 110/70. If you're not sure about your blood pressure, kindly visit the nearest pharmacies to check and inform Tim about your latest blood pressure)

Do you smoke?

Do you drink alcohol?

How much do you do physical exercise per week?

Do you have any food restrictions?

Current diet?

Do you have any underlying medical conditions? Please tick and if yes, please specify medications 

  • Diabetes Mellitus

  • High Blood Pressure

  • High Cholesterol

  • Coronary Heart Disease

  • Stroke

  • Chronic Kidney Disease

  • Others, please specify

When was your last medical check-up done?

Please answer the question(s) marked in red to submit. 

Thank you. Well submitted!


© 2020 by Plant Based Health Alliance

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