Secure patient forms Encrypted on your device

Before your visit

Your health forms

Checking your link…

Please complete both forms before your consultation. They take about 25 minutes in all, and you can do them one at a time. Have your medicines (or their boxes) nearby.

Please complete this check-in before your follow-up visit. It takes about 8 minutes. Have your medicines (or their boxes) nearby.

Your answers are encrypted in this browser before they are sent. Only SSMC clinic staff, using the clinic’s private key, can read them. Staff add them to your medical record and then delete them from this website; anything not deleted is erased automatically after 30 days. Nothing is saved on this device after you close the page.

INT-00 · about 15 minutes

Functional Health Assessment

Not started INT-02 · about 10 minutes

Medical History & Review of Systems

Not started FU-Q · about 8 minutes

Follow-Up Questionnaire

Open the personal link we sent you by message or email, or type the code from that message. If the message says the forms ask for your medical record number (MRN), type it too — it is on your SSMC card and your receipts.

Your code

Your medical record number (MRN) — only if your message asks for it

No code yet? The clinic sends one when your visit is booked: call +855 86 33 03 38 or Telegram +855 86 33 03 63.

This link is protected. Please type your SSMC medical record number (MRN) to open your forms. It is on your SSMC card and your receipts; if you cannot find it, call +855 86 33 03 38.

Your medical record number (MRN)

Code · use a different code

SSMC Pain & Wellness · Sing-Specialists Medical Centre · Phnom Penh Questions: +855 86 33 03 38 · Telegram +855 86 33 03 63 · enquiry@singsmc.com