Initial Health Assessment – Single Entry

Initial Health Assessment – Single Entry

by October 27, 2020

Displaying 1 - 12 of 12

PT00512
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
12/06/2021
Salim E Mkirani
04/05/1987
P o Box 49660, Nairobi Nairobi
Kenya
Map It
Male
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
176
65
85
85
12
Medical History: Diabetes and Other Chronic Conditions
No Diabetes Diagnosis
  • None
No
I'm not sure yet. What other options are available?
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
10 - Very Confident
Word of mouth (friend, family, acquaintance)
  • Losing Weight
  • Having More Energy
  • Improving Metabolic Health
  • Improving Mental Health
  • Lose Weight
  • Better Focus
  • More Energy
PT00511
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
07/06/2021
Caroline nduta Wanjiku
02/27/1981
Nairobi, Nairobi 00100
Kenya
Map It
Female
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
158
96cm
91
122.5cm
34.5cm
No
Medical History: Diabetes and Other Chronic Conditions
No Diabetes Diagnosis
  • Over Weight / Obesity
No
I'm not sure yet. What other options are available?
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
1 - Not Confident
Healthcare provider (doctor, nurse, etc)
  • Losing Weight
  • Having More Energy
  • Improving Metabolic Health
  • Improving Mental Health
  • Improve metabolic health
  • Lose weight
  • Have more energy
PT00510
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
22/01/2021
Test Tester Four
12/18/1994
Makindu, Makueni 90138
Kenya
Map It
Male
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
174
45
76
40
25
Medical History: Diabetes and Other Chronic Conditions
DIABETES Type 2
Yes, but in the past. I don't currently take insulin
Yes
Medication Dosage Frequency
metformin 500mg 0nce
  • metformin
  • None
No
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
4 -
Word of mouth (friend, family, acquaintance)
  • Reversing Type-2 Diabetes or Prediabetes
  • Reducing / Eliminating Diabetes Medication
  • Losing Weight
  • Reverse diabetes
PT00509
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
09/01/2021
Richard Kamau Wambu
10/03/1965
69907, Nairobi Nairobi
Kenya
Map It
Male
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
161.5
33.6
57
365
5
Medical History: Diabetes and Other Chronic Conditions
hypertension
I've never taken insulin
Yes
Medication Dosage Frequency
Treviamet 50/500mg Twice a day
Diamicron 30mg Once a day
  • Treviamet
  • Diamicron 30mg
  • Hypertension
No
Medication Dosage Prescription Duration
Losartan 50mg Once a day
  • Losartan
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
No
No
10 - Very Confident
Online Ad (Facebook, Instagram, Google, etc)
  • Reversing Type-2 Diabetes or Prediabetes
  • Reversing Hypertension
  • Reverse type 2 diabetes
  • Reverse hypertension
PT00508
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
09/12/2020
Mary Vodembeke Mugivane
07/30/1954
P.O 1312-, transnzoia 30020
Kenya
Map It
Female
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
164cm
above 80
75
above 80
above 24
No
Medical History: Diabetes and Other Chronic Conditions
hypertension
Yes, I'm currently taking insulin
Yes
Medication Dosage Frequency
amaryl m2 250mg once daily
  • amaryl m2
  • Hypertension
No
Medication Dosage Prescription Duration
nifedipin b d 12 years
  • nifedipin
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
10 - Very Confident
Word of mouth (friend, family, acquaintance)
  • Reversing Type-2 Diabetes or Prediabetes
  • Reducing / Eliminating Diabetes Medication
  • Reducing A1c
  • Reducing Blood Pressure
  • Reversing Hypertension
  • Improving Metabolic Health
  • Improving Mental Health
  • reversal of hypertension and diabetes
PT00506
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
11/11/2020
Caroline Wanjiku Muiruri
11/16/1986
75, Makueni 90138
Kenya
Map It
Female
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
164
93
80.5
110
37.5
No
Medical History: Diabetes and Other Chronic Conditions
DIABETES Type 2
Yes, but in the past. I don't currently take insulin
No
  • Over Weight / Obesity
No
My employer, health insurer, or provider has told me that I'm covered for the REVERSED+ Treatment
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
5 -
Word of mouth (friend, family, acquaintance)
  • Reversing Type-2 Diabetes or Prediabetes
  • Reducing A1c
  • Losing Weight
  • Having More Energy
  • Improving Metabolic Health
  • Improving Mental Health
  • Reversing Diabetes
  • Improving mental health
  • Losing weight
PT00505
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
10/11/2020
Esther Moige Ngare
04/01/1984
2620, Kisii Kajiado
Kenya
Map It
Female
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
154
39
82
44
16
No
Medical History: Diabetes and Other Chronic Conditions
Prediabetes
I've never taken insulin
Yes
Medication Dosage Frequency
Treviamet 50/500 Morning,
Metformin 500mg Evening
  • Treviamet
  • Metformin
  • Other

Raised thyroid antibodies, hypothyroidism

No
Medication Dosage Prescription Duration
Thyroxine 75mcg
  • Thyroxine
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
10 - Very Confident
Online Ad (Facebook, Instagram, Google, etc)
  • Reversing Type-2 Diabetes or Prediabetes
  • Reducing / Eliminating Diabetes Medication
  • Reducing A1c
  • Losing Weight
  • Getting Control of Blood Sugar
  • Having More Energy
  • Improving Metabolic Health
  • Improving Mental Health
  • Other
  • Eliminate pre-diabetes state, loose weight,
  • Having a healthy pregnancy
  • Eliminating diabebetes medications
PT00504
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
09/11/2020
Martin Waweru Njoroge
12/23/1983
924, Muranga Central
Kenya
Map It
Male
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
153
38
85
42
10
Medical History: Diabetes and Other Chronic Conditions
No Diabetes Diagnosis
  • None

NA

No
Medication Dosage Prescription Duration
NA Na
  • NA
I'm not sure yet. What other options are available?
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
6 -
Online Ad (Facebook, Instagram, Google, etc)
  • Losing Weight
  • Loss weight
PT00503
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
07/11/2020
BENEDICT MUTHIANI MALONZA
04/03/1953
76565, NAIROBI 00508
Kenya
Map It
Male
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
168cm
94cm
78kgs
102cm
30cm
Medical History: Diabetes and Other Chronic Conditions
DIABETES Type 2
I'm not sure
Yes
Medication Dosage Frequency
Linagliptin ( Trajenta)and gliboral Both 5mg
  • Linagliptin ( Trajenta)and gliboral
  • Hypertension
No
Medication Dosage Prescription Duration
Co-micardis and Nebilet 80/12.5 mg and 5mg respectively Daily and to continue taking
  • Co-micardis and Nebilet
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
1 - Not Confident
Webinar of 6/11/2020 by Dr Mulatya and others
  • Reversing Type-2 Diabetes or Prediabetes
  • Reducing / Eliminating Diabetes Medication
  • Reversing Hypertension
  • Getting Control of Blood Sugar
  • The three ticked conditions
PT00502
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
07/11/2020
Grace Wangui Gachagua
08/28/1971
Kiambu, central 33353-00600-Ngara
Kenya
Map It
Female
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
121.92 cm
60 cm
53
92cm
32cm
No
Medical History: Diabetes and Other Chronic Conditions
DIABETES Type 2
Yes, but in the past. I don't currently take insulin
No
  • None
No
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
10 - Very Confident
DRM-kenya-Zack
  • Reducing A1c
  • Getting Control of Blood Sugar
  • Other
  • getting control of blood sugar
PT00501
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
07/11/2020
Serah Ndanu Mwendwa
12/04/1966
1505–90100, Machakos Eastern
Kenya
Map It
Female
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
180cms
98cm
80kgsw
112 cm
31 cm
No
Medical History: Diabetes and Other Chronic Conditions
DIABETES Type 2
I've never taken insulin
Yes
Medication Dosage Frequency
Diamicron MR and stagliptin 30 mgs & 50 mgs Once daily
  • Diamicron MR and stagliptin
  • Hypertension
No
Medication Dosage Prescription Duration
Losartan H 50 mgs Monthly
  • Losartan H
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
None
Webinar
10 - Very Confident
Online Ad (Facebook, Instagram, Google, etc)
  • Reducing / Eliminating Diabetes Medication
  • Reducing A1c
  • Reducing Blood Pressure
  • Reversing Hypertension
  • Managing Chronic Arthritis
  • Getting Control of Blood Sugar
  • Having More Energy
  • Improving Metabolic Health
  • Improving Mental Health
  • Eliminate Type 2 diabetes, Reverse hypertension and good health
PT00500
The information in this assessment will be kept strictly confidential and will be reviewed by a Healthcare Practitioner for the sole purpose of recommending the best level of service for you. Submitting this assessment is at no cost to you and does not commit you to enroll in the REVERSED+ Treatment Program.
I am filling as the patient
05/11/2020
Eric Mulatya
12/17/1979
Nairobi, ENG 28804
Kenya
Map It
Male
Kindly note that since you are filling this form on behalf of the patient, the guardian's phone number and email address will be used for future communication between the REVERSED+ team and the patient.

To change this, please click the BACK button and fill the form using the patient's details.

Email hidden; Javascript is required.
English
Yes
The following measurements are required for the Initial Health Assessment. All measurements are in Centimeters and Kilograms
174
45
76
40
25
Medical History: Diabetes and Other Chronic Conditions
Prediabetes
I'm not sure
No
Medication Dosage Frequency
metformin
  • metformin
  • None
  • Other
No
I'll pay out of pocket
Health insurance coverage information and other payment options. Please note that filling in this information is free and there is no obligation
The REVERSED+ Treatment Program costs as low as (Kenya Shillings) Sh7,500 per month, and there are affordable yearly subscription packages as well.
1 - Not Confident
Healthcare provider (doctor, nurse, etc)
  • Reversing Type-2 Diabetes or Prediabetes
  • Reverse diabetes
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