Arthritis and Pain Clinic Consultant Rheumatologist

Location:

UPMC Aut Even Hospital
Freshford Road, Kilkenny Ireland R95 D370
Tel: 00353-56-7775146
Email: rheumatologyclinics@gmail.com

Language Options:

Online Consultations

Second Opinion In Rheumatology

For an online detailed medical and a comprehensive report or a Second opinion on your condition, please fill in the form and a detailed medical report will be e mailed to you upon the receipt of €250 inclusive of VAT payable by the credit card.

YOUR DETAILS

Title:

Surname: *		Given Name: *

Mobile Ph: *		Home Ph:

Email: *		Age: *

YOUR CURRENT PROBLEM

TREATMENTS
Have you had any treatment for your condition:

Physiotherapy	Chiropractic Hydrotherapy	Accupuncture Massage

Other

IMPORTANT INFORMATION : Please Click on either Yes or No.

Do you take any blood thinning medication: Yes No

Do you smoke Cigarettes: Yes No

Do you Drink any alcohol: Yes No

Do you have Diabetes: Yes No

Do you suffer from tiredness?: Yes No

Do you suffer from poor sleep?: Yes No

Have you have surgery on your Spine (Neck or Back) before: Yes No

Have you been diagnosed with cancer before: Yes No

PLEASE CLICK IF YOU HAVE HAD ANY OF THE FOLLOWING PROBLEMS:

MEDICATIONS: (For each medication—please type in the name, then Click on +Add more for another medication).

Enter Medication here

INVESTIGATIONS:

Please click on any investigations that you have had:

X-rays (Which joint(s) was the X Ray performed on and what was the result? Please include if a chest X ray was performed and what was the result?)

MRI scan (Which joint(s) was the M.R.I performed on and what was the result?)

Ultrasound of joints (Which joint(s) was the ultrasound performed on and what was the result?)

Nerve conduction study

CT scan

Bone scan

Spinal Injections

Have you previously attended a Rheumatologist?

Yes No

If you want a detailed medical report on your condition or a second opinion,please pay by credit card €250 inclusive of VAT and a comprehensive medical report will be e mailed to you: *	Yes No

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