First Name *

Last Name *

Preferred name

Relationship to the Patient *

Phone Number *

Email *

WeChat

Line

Other IM

Country of Nationality *

Date of Birth *

Country of Residence *

State/Province

Address Line 1*

Address Line 2

City *

Post Code

Gender

Male

Female

Cancer Type *

Diagnosis Status *

Treatment Status

Medical Status*

Diagnosis Date*

Health Insurance

Purpose: Collect detailed clinical data for accurate diagnosis and treatment planning.

Diagnosis Records

Pathology Report

MRI & PET-CT

Upload Other Reports

(Such as Laboratory Results; Treatment Records; Genetic Testing Results; Hospital Discharge Summaries; Other Relevant Documents)

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