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Age (*)

Contact Number (*)

Email (*)

Date Of Birth[DD/MM/YYYY](*)


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Present Complaints & cause of the diseases- (*)

Any Past Illness & treatment taken-

Present Medication if any-

Investigation Reports if any-

Note - You can also send scanned reports/relevant documents to & we will get back to you within 24 Hrs.If you want Dr.Wani to see your reports personally,please wait for 36 Hrs & put ATTN Dr. Wani in the subject line.