Beauty Clinics Treatment Form
Fill in all the fields, if you want complete treatment

The following Performa is formulated to help you to specify your problems correctly & this enable to analyze your ailments accurately. Our chief Hakeem Sahib personally goes through every e-mail & a panel of expert Hakeems review every individual case. Our unani medicines has a legacy of more than 1000 years of tradition & knowledge and our treatment course are prepared strictly in accordance with the age old medical scripts, texts & manuals of unani with the help of modern scientific tools. Now world renowned  western doctors has conceded that where modern medicine failed to cure, there "unani herbalism" steps in to cure the incurable. Today unani medicine is recognized worldwide by World Health Organization (WHO) as one of the alternative system of medicines & forms an integral part of national health care delivery system. For those who are unable to find a solution, we show them rig direction through our valuable consultation. We remind you that the root cause of all beauty disorders lies in the ignorance, bad habits, wrong life styles & unnatural sex acts of younger days. These destroy one’s own body & health. Our treatment will certainly help you to have eternal beauty youth & ageless beauty.

*Name
*E-mail
*Address
*City
*State
*Zip Code
*Country
Age
Sex Male   Female
*Mobile Number
*Phone Number
*Fax Number
Are you married Yes    No
Weight / Height /
Occupation
Are you suffering form diabetes Yes    No
Are your suffering from

HBP
LBP
Not at all

Are you suffering any sexual disease Yes    No
Are you suffering from leucorrehea Yes    No
Are you Vegetarian    nonvegetarian
Which type of food you like Spicy    Mild
Do you have gastric problem Yes    No
Do you sleep well Yes    No
What about your memory Sharp    Weak
Have you ever been operated
If yes, give detail
Yes    No
Have you ever been treated in past
  Yes       No
  If so, What kind of treatmen
        Homeopathic             Allopathic            Ayurvedic             Unani

Is your problem hereditary Yes    No
Do you have skin allergy Yes    No
Is your hair falling Yes    No
Problem since how long
Type of Skin Oily Dry
Main Topic
Comments
 

    


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