Venkateswara Ayurveda Nilayam Ltd (Since 1925) Online Dr. Consultation Form
We will respond back for all your queries within 24 to 48 hours. All consultations will be personally handled by our Chief Physician. For more information please visit www.VanChintaluru.Com
Enter your full name *
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Your email Id *
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Mobile number *
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Address (Line One) *
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Address (Line Two)
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City Name *
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Postal Pin code *
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State *
Country *
Type in your health issues and specify if you are using any other medicines at present *
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Are you a diabetic? *
If yes then since when you are a diabetic? (10 years, 2 years etc)
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If yes then provide your sugar levels on fasting and post lunch
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Is there a diabetic in your family tree? *
Your Age *
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Gender *
Your Height (5.6, 5.9 feet etc) *
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Your Weight (in Kgs) *
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Your Occupation *
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Does your work involve sitting in front of a computer? *
Are you a Vegetarian or Non Vegetarian? *
Consume Alcohol? *
Are you a smoker? *
Any other forms of tobacco? (Gutkha / Khaini etc) *
Age of your father & Status of his health? *
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Do you suffer from high blood pressure, if so what is your cystolic and diastolic readings? *
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Are you suffering from any liver disorders ? If yes please specify *
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Are you suffering from any skin infections? *
Do you suffer from constipation? *
Have you undergone any major surgery ? If yes please provide more details on the surgery details. *
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Are you suffering with any allergies? *
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