Contact Us

Detailed Form

If you wish to send a brief query, and not this detailed one, use the chat application at the bottom right corner of your screen.

Please note, This Proforma is to help you to mention the issues relevant to us to sort out your problem. Even if you are unable to give all these details in the initial communication, you can add them subsequently, when suitable. Fields not relevant in your case - please mention not applicable (NA).

Send Us Detailed Query

Name:

(If you have concerns even after going through our Privacy policy, you may use a name of your choice - we do not need to verify your identity)

Age:

Gender:

Male
Female

Current Location:

(Decisions choice of procedures, issues in before and after surgery care would depend on both - the place of present residence & place/region of ORIGIN)

Originally from:

Telephone:

Email:

Please enumerate your Present problem. Mention the time since each has been noticed.

(Serially, 1,2,3...)

Any other medical problems

Diabetes (high sugar), Hypertension (High BP), high Cholesterol

Any previous surgery? Any problems during treatment?

Any other treatment for the same in the past?

Any drug/food allergy you are aware of

Any medicines/pills you are taking at present - health supplements?

Any smoking, alcohol, or other habits - if yes further relevant details

For those wanting to loose body fat/weight, any efforts at Exercise or Diet control?

Finally, the purpose of getting the problem corrected:

Common causes include
To correct the physical discomfort in day to day life
To improve my self-confidence and self-esteem - to feel better basically
To make someone happy - spouse/partner
To improve opportunities in life - in personal life (marriage) OR at work

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Thank You