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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
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