Penis Treatment Form
(Please fill up all the fields)
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. Unani herbalism is the only health science which makes enlargement permanent with the help of herbs and minerals and without any side or negative effects.
   
*Name
*E-mail
*Address
*City
*Zip Code
*Country
*Age
* Mobile Number
* Phone Number
* Fax Number
*Weight
*Height
*Occupation
Does the discharge of semen occurs during sleep Yes No
Do you feel your penis is bent or loose towards the leftside Yes No
Do you feel weakness after the intercourse Yes No
Are you suffering from premature ejaculation Yes No
Do you get perfect erection before intercourse Yes No
What is your duration of intercourse
Do you have the habit of masturbation
If so , since how long 		Yes     No
What is the length of your organ befor erection
What is the length of your organ after erection
How much you want to increase
How many times night discharge occurs in a week
Does your underwear get wet when you see nude photographs Yes No
How many times you urinate during night
Do you exercise daily Yes No
Do you feel pain after urine Yes No
Are you suffering from diabetes Yes No
Are you suffering from any contagious disease Yes No
Do you feel pain in balls Yes No
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