Register with us by filling out the form below.RM_StatsPatient First Name *Patient Family Name *Patient Country *--Select Country--AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambia, TheGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and the McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIraqIranIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Republic OfKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandTaiwanTajikistanTanzania, United Republic OfThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePatient WhatsApp Number *⚠️ Ex: +2203012345 (including international code)Phone Operator *Select an optionAfricellComiumGamcelOrangeQcellSierratelOther...Once the appointment is confirmed, we send internet credit to the patient's phone number before the consultation (except for Liberia unfortunately). This will allow him to connect without regard to the data.Patient Age *Select an option0 years old1 years old2 years old3 years old4 years old5 years old6 years old7 years old8 years old9 years old10 years old11 years old12 years old13 years old14 years old15 years old16 years old17 years old18 years old19 years old20 years old21 years old22 years old23 years old24 years old25 years old26 years old27 years old28 years old29 years old30 years old31 years old32 years old33 years old34 years old35 years old36 years old37 years old38 years old39 years old40 years old41 years old42 years old43 years old44 years old45 years old46 years old47 years old48 years old49 years old50 years old51 years old52 years old53 years old54 years old55 years old56 years old57 years old58 years old59 years old60 years old61 years old62 years old63 years old64 years old65 years old66 years old67 years old68 years old69 years old70 years old71 years old72 years old73 years old74 years old75 years old76 years old77 years old78 years old79 years old80 years old81 years old82 years old83 years old84 years old85 years old86 years old87 years old88 years old89 years old90 years old91 years old92 years old93 years old94 years old95 years old96 years old97 years old98 years old99 years oldPatient Gender *Select an optionFemaleMalePatient Languages * English Français Mandinka Pulaar / Fulla Wolof Symptoms * Fever Headache Stomach ache Vomiting or nausea Diarrhoea Runny nose Sore throat or cough Breathing difficulties Chest pain (rib, lung, heart) Fatigue Muscles ache Chills or sweating Bleeding Genital problems Loss of consciousness Skin problems Chronic Disease or Pregnancy *Select an optionNoPregnantHIVHypertensionDiabeticHeart DiseasesLiver DiseasesTuberculosisCancerOthersIn addition to your symptoms, do you have a chronic disease that we need to know about?Email Address *The email is required to create your account on Medeecal.Password *Password must be at least 7 characters long.Enter password again *Password must be at least 7 characters long.⚠️ We do not ask for the password of your personal email address. Just choose a password to create your account on Medeecal. Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
