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REGISTER YOUR NAMES WITH CONFIDENCE FOR MEDICAL AND
HEALTH TOURISM IN OUR AGENCY THROUGH OUR E-MAIL
Name of the Patient
*
Age
*
years
Sex
Male
Female
Address
Email
*
Phone No.
Fax No.
For Certain Important Diseases you can get Modern Indian Herbal & Ayurvedic Medicines from India from us.
Height
cm
Weight
kg
Married
Yes
No
Children
Yes
No
Satisfactory Sex
Yes
No
Impotency
Yes
No
Smoking / Drinks
Yes
No
Diabetes
Yes
No
Hypertension
Yes
No
Traveling often
Yes
No
Family / Business Worries
Yes
No
Any Investigations done earlier ?
Yes
No
Any Drugs Taken
Yes
No
Any Other Diseases Treated
Yes
No
Any Operation Done
Yes
No
Good Appetite / Sleep
Yes
No
Constipation / Burning / Micturition
Yes
No
Any Skin Diseases
Yes
No
Please enter your complaints or the problems you have. Our Panel of Experts in various Systems to Medicine will give you their Medical Consultation.
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