Consultation Form - Sanatan Wellness

Sanatan Wellness Consultation

Step - 1

Full Name

Father's Name

Profesion

Age

Select Gender

Male

Female

Others

Full Address

Pin Code

Phone Number

Whats App Number

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Height

Weight

Diet Chart

Blood Pressure

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Blood Sugar

Constipation

Do you take any medications?(if yes please share the detail else say NO) *

Did you have any surgery in the past?(if yes please share the detail) else say NO *

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For how long have you been taking this/these Medicines? Else say NO *

Please share all the diseases in a sequence year wise and if any symptoms you have, please specify? *

Please upload your updated reports regarding your health condition, in case new reports are not present then you can upload your old reports?

I Agree I have read the Terms & Conditions