Dear Patron,

Whatever the illness, just fill out this short form for a free, confidential consultation with our Chief Physician. We commit to addressing your questions within 24 to 48 hours. Rest assured, all consultations will be directly managed by our Chief Physician.

Your details are 100 % confidential and visible only to our certified doctors.

Full Name *

Mobile Number *

Email ID *

Address *

Town / City *

Pin Code *

Country *

State *

Type in your health issues and specify if you are using any other medicines at present.*

Are you a diabetic? *

Since when you are a diabetic? (Answer 'NO' if you are a non-diabetic)*

If yes then provide your sugar levels on fasting and post lunch (Please provide the readings within the last one week for better medical advise). (Answer 'NO' if you are a non-diabetic) *

Is there a diabetic in your family tree? *

Your Gender? *

Your age? *

Your Height *

Your Weight (in Kgs) *

Your Occupation *

Are you a Vegetarian or Non Vegetarian? *

Do you consume alcohol? *

Are you a smoker? *

Any other forms of tobacco? (Gutkha / Khaini etc.) *

Do you suffer from high blood pressure? *

Systole*

Diastole*

Are you suffering from any liver disorders? If yes please specify. *

Have you undergone any major surgery? If yes please provide more details on the surgery details. Like type of surgery and how many years back its been done. *

Any other health complaints (or) disorders if you or anyone in your family history please provide details here. If you have more than one complication please mention all of them with number of years you are suffering from. *

Attach Reports (Optional)
You can upload a maximum of 5 attachments or reports.

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AYUSH Licence No.:
A - 02/Ayur.

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Online Doctor Consultation Form

Your details are 100 % confidential and visible only to our certified doctors.

Your Consultation Request Has Been Submitted

AYUSH Licence No.: A - 02/Ayur.

Useful Links

My Account

Our Policies

Got Question? Call Us

Doctor Appointment

Clinic Timings

8AM - 12PM & 3:30PM - 5:30PM

AYUSH Licence No.:
A - 02/Ayur.