In case your problem is not getting solved by the self exercises videos uploaded on our YouTube channel "@DEEPAKKUMARCAPRI" please fill our online form given below, and after we receive your details, and in case it comes under our specialty, we will guide you, by sending specific video clips for your problem, along with number of repetition / amount of resistance to be used to perform those exercises.
Sending these customised detailed exercise videos will cost you rupees 101/- only, in addition you may also consult our highly qualified physiotherapist online for further advice at a minimal cost of rupees 250/- only
Incomplete form and inappropriate replies will not be entertained and wont be replied to, filling all fields are important. Incase it is not applicable to you, please fill NA.
Give as much detail as possible as it would help your doctor to understand your problem in a better way.
Disclaimer1: All the information collected below is for assessment purpose only in order to help our patients. This information will not be shared with anyone in any form whatsoever it may be. This information will be kept confidential at all times. This information will not be used for any marketing purpose whatsoever it may be. In case we contact you, we will contact you only in order to discuss and guide you on the present problem given below by you. PLEASE FILL EACH FIELD CAREFULLY, YOU WILL NOT BE ABLE TO EDIT OR RESUBMIT IT
NAME (First Name, Last Name)
AGE (in years)
Field Work/ Walking
WhatsApp Number (+91xxxxxxxxxx)
City and State
Never submit passwords through Google Forms.
This form was created inside of Capri Spine Clinic.