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Diabetic Patient Data Registry for Diabetic Retinopathy
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Name
*
Your answer
Email
Your answer
City
*
Your answer
Phone number
*
Your answer
Duration of Diabetes
Your answer
Last Sugar Report
Your answer
Treating Doctor Name
Your answer
Treating Doctor Contact Number
Your answer
Treatment Prescription
Your answer
Other Health Issues
Your answer
Last Eye Check Up Done
Your answer
Are you Diagnosed with Diabetic Retinopathy
Your answer
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