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DISEASE CATEGORY
01. Disease of Eye
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07. Heart
08. Skeletal and Muscular Diseases
09. Respiratory Diseases
10. Digestive Diorders
11. Kidney
12. Gynic Disease
13. Male Diseases
14. Nervous System Disease
15. Mentaly
16. Weight Relative Problem
17. Hair Problem
18. Endocrine Glands


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Consultancy Form

Helpline: 90799-38462

Description

Subscription : $10 or 300

Prospectus

Treatment Form

* Required Fields  
   
Form No T-26
Disease/Disorder : Diplopia
* Name :
Gender : Male Female
Father Husband Guardian Name :
Address :
City / Town :
State :
Country
E-mail :
* Contact No.:
Occupation:
DOB :
Age:
Weight :
Disease/Complaints/Pain/Problem :
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 :
* Mode of Payment for Subscription :   Payment Options
I myself come for treatment on my own responsibility. Doctors & Institute are not responsible for any cause.

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