Female Treatment Form
Fill all the Fields, If you want Complete Treatment

The following proforma is formulated to help you to specify your problems correctly & this enable to analyze your ailments accurately. Our chief Hakeem Saheb 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 medicines are prepared strictly in accordance with the age old medical scripts, texts & manuals of unani practice 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 right direction through our valuable consultation. We remind you that the root cause of all sexual 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 live a long life free from these diseases.

   
*Name
*E-mail
*Address
*City
*State
*Zip Code
*Country
*Mobile Number
*Phone Number
*Fax Number
 
Age
Weight
Height
Occupation
Mention the reason your pregnancy failures
When did you get your pregnancy last
   
Do you have child bearing problem
If so, since how long		 Yes No
How about your mensuration period

If early or delayed, mention the days

Normal Early Delayed

How many days your mensuration lasts
Do you feel extreme pain at the time of mensuration Yes No
Do you get normal sleep Yes No
How many times you pass urine during night
Do you feel to much hungry Yes No
Do you have constipation Yes No
Do you feel uncomfortable or pain while passing urine Yes No
Do you feel extra pain at the time of (intercourse) union with your male companion Yes No
Is your husband suffering from any sex related disease
If so specify		 Yes No
Have your husband taken any treatment or test for infertility or any other sex disorder
If so, specify		 Yes No
How about your memory Sharp Weak
Do you feel irritation in both legs and hands Yes     No
Do you smoke Yes     No
Do you take alcoholic drinks regularly     Occasionally Never
What kind of medicines you have taken earlier to cure your problem
 
Specify whether you have done the following tests:
   

1. Fallopian Tubes
Closed or Damaged EitherBoth Or One

2. Uterus
Whether there is tumours or infection?
Yes       No

3-. Ovaries
Whether the mouth closed
Yes No

   
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