User details
Title
Mr
Mrs
Ms
Dr
*Preferred First Name
*Full Name(s)
*Surname
ID/Passport Number
*Date of Birth
Gender
Male
Female
Race
African
Asian
Coloured
White/Caucasian
Other/Unsure
Mobile Number
Tel Number
*Email Address (not used previously at Geneway)
Estimated Weight (kg)
Estimated Height (m) eg 1.82
Estimated Waist Circumference (cm)
Estimated Hip Circumference (cm)
Blood Pressure
Low
Normal
High
Unsure
Physical Address line 1
Physical Address line 2
City
*Province
*Country
*Postal or Zip Code
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Contact lab@geneway.co.za for help with the registration process
Fields marked with '*' is compulsory