Consultancy Form | ACUPRESSURE|ACUPUNCTURE|NATUROPATHY|ALTERNATIVE MEDICINE THERAPY TREATMENT CENTER

DISEASE CATEGORY

Comments

I have undergone treatment for Cervical Spondylitis from Acupressure Research , Training and Treatment Institute and got unbealiveable result.
- Anil
I take a treatment from a therapist which is useful in our clinic
- Ravi
There is a revolutionary campaign in the field of health.
- Santosh Kumar Fauzdar

Consultancy Form

Helpline: 90799-38462

	*Required Fields
Disease Name :
*Name :
Sex :	Male Female
*Father's / Husband's / Guardian's Name :
Address :
*City / Town :
State :
Country
*E-mail :	Example: acupressure@dataone.in
*Contact No.:
Occupation:
Age:
Birth Date :
Weight :
Disease/Complaints/Pain/Problem :
*Mode of Payment for Subscription :	Payment Options
Sleep :	Disturbed Sound With Dreams
Urine & in day :	( times )
Pain:	before during after
Urine & in night :	( times )
Pain:	before during after
Stool/Feces :	Normal Constipation Hard Loose
Hunger :
Thirst :	Normal More Less
Taste :	Sour Sweet Salty
Menstrual Cycle :	Clots Scanty Excess Normal
Attitude :	Grumpy Sprightly Concerned Depressed Fearful
Habit :
Past/Family History :
Pathology :
B.P. :
Clinical Examination/Investigation Report :
Other Report :
Diagnosist :
Treatment undergoing at present :
I myself come for treatment on my own responsibility. Doctors & Institute are not responsible for any cause.