CONSULTATION

Here we provide a facility to you, to seek remedies for your problems. Kindly fill the following details carefully, which may help us to understand your problem and hence can suggest a good treatment to you. Our Chief Physician Ashtavaidyan Alathiyoor Narayanan Nambi will suggest the treatments for your good health.

Offline Remedies for your Problems

Name :

Last Name:
Street:

City:

State:

Country:

Zip/Postal Code:

Telephone:

Fax:

E-mail:

Age:

Sex: MaleFemale

Weight:

Structure: Obese LeanMedium

Occupation &

Nature of Work:

Present Complains with full history:

Past History(Previous problems & surgery):

Any chronic illness like   Diabetes/Hy.tension/TB/

Heart Diseases/& medicine taken now:

Has the patient's relatives had the same problem: Yes No

   Any cause known to you for the disease:

State of digestion, motion,micturition, appetite and sleep:

Marital Status:
Married Unmarried

Treatment done so far:

Recent investigation reports

   (blood, urine, motion, x-ray, CT scan etc:)

Blood pressure:

	Copyright © 2007 S.N.A. Oushadhasala PVT LTD, All Rights Reserved
	Thrissur- 680 005, Kerala, India, Tel: (91-487) - 2420948, 2441947, Fax: (91-487) - 2441948
	Email: mail@thaikatmooss.com