Body Disorders


Herbal Supplements


Diseases


Ingredients


read more..

Sindh Healthcare Sdn Bhd
22-1, Jalan MP-10,
Taman Merdeka Permai
75350 Melaka, Malaysia
Email: info@sindhhealth.com

Phone: +606 334 6294

Mobile : + +6012 713 9671.

Email : mir@sindhhealth.com


Consultation


For consultation you can contact our competent team of Hakims and Vaids who implement and monitor the quality of our products. Doctors, Hakims and Vaids prescribe the Herbal Supplements with full confidence as they come from Dehlvi Naturals.



Enquiry Form

General

( * fields are mandatory)

Email Address * :
Name of Patient * :
Age (Yrs.) * :
Weight (Kg) :
Height :
Profession :
Marital Status * : Married Unmarried
Complete Postal Address :
City * :
State * :
PIN / Zip Code :
Country * :
Phone No. with STD code (Optional) :
Do you suffer from Hypertension ? * : Yes   No
If yes, mention your BP : Diatolic
Are you suffering from Diabetes ? * : Yes   No
If yes, mention Blood Sugar Level : Fasting Random
1 Main problems * :
2 For how long, are you suffering from these complaints ? :
3 Appetite : Good  Average   Poor
4 Motion : Normal  Constipation  Loose
5 Food Habit : Vegetarian  Non-Veg
6 Built : Fat  Moderate  Thin
7 Do you have the problem of burning chest ? : Often  Sometimes Never
8 Do you suffer from headache ? : Often   Sometimes  Never
9 Do you suffer from sleeplessness ? : Often   Sometimes  Never
10 Do you smoke or chew tobacco ? : Yes   No
11 Do you drink excessive tea or coffee ? : Yes  No
12 Do you consume alcohol ? : Yes   No
13 If you have suffered from any major disease earlier, kindly do mention it here ? :
14 If there is a history of any hereditary disease in your family, kindly do mention it here ? :
15 If you have undergone any medical investigations, kindly mention here :
16 Any other problem, which you would like to describe :
17 Word Verification *  

Male

( * fields are mandatory)

Email Address * :
Name of Patient * :
Age (Yrs.) * :
Weight (Kg) :
Height :
Profession :
Marital Status * : Married Unmarried
Complete Postal Address :
City * :
State * :
PIN / Zip Code :
Country * :
Phone No. with STD code (Optional) :
Do you suffer from Hypertension ? * : Yes  No
If yes, mention your BP : Systolic Diatolic
Are you suffering from Diabetes ? * : Yes No
If yes, mention Blood Sugar Level : Fasting Random
1 Main problems * :
2 Appetite : Good  Average  Poor
3 Motion : Normal  Constipation  Loose
4 Food Habit : Vegetarian Non-Veg
5 Built : Fat  Moderate Thin
6 Do you smoke or chew tobacco ? : Yes, Regularly  Sometimes Never
7 Do you feel burning sensation while passing urine ? : Often  Sometimes  Never
8 Are you suffering from involuntary flow of sticky fluid in urine ? : Often Sometimes Never
9 Are you suffering from nocturnal emissions ? : Often Sometimes Never
10 If yes, then how many times a month ? :
11 Are you suffering or have ever suffered from any Sexually Transmitted Infection (e.g., Gonorrhoea, Syphilis, HIV, etc.) ? : Yes No
12 Are you suffering from any of these problems: :
  (a) Erectile Dysfunction : Always Sometimes Never
  (b) Lack of Stiffness : Always Sometimes Never
  (c) Premature Ejaculation : Always Sometimes Never
  (d) Lack of Desire for Sex : Always   Sometimes Never
13 If there is any deformity in the male organ, please clarify :
14 If you have undergone any medical investigations, kindly mention here: :
15 Any other problem, which you would like to describe : :
16 Word Verification *  

Female

( * fields are mandatory)

Email Address * :
Name of Patient * :
Age (Yrs.) * :
Weight (Kg) :
Height :
Profession :
Marital Status * : Married Unmarried
Complete Postal Address :
City * :
State * :
PIN / Zip Code :
Country * :
Phone No. with STD code (Optional) :
Do you suffer from Hypertension ? * : Yes No
If yes, mention your BP : Systolic Diatolic
Are you suffering from Diabetes ? * : Yes No
If yes, mention Blood Sugar Level : Fasting PP Random
1 Main problems * :
2 Appetite : Good  Average Poor
3 Motion : Normal Constipation Loose
4 Food Habit : Vegetarian Non-Veg
5 Built : Fat Moderate Thin
6 Do you have the problem of burning chest ? : Often Sometimes Never
7 Do you suffer from headache ? : Often  Sometimes Never
8 Do you suffer from sleeplessness ? : Often Sometimes Never
9 Do you suffer from any irritation or burning sensation when passing urine ? : Often  Sometimes Never
10 Do you have the problem of white discharge / leucorrhoea ? : Often Sometimes Never
11 Do you have pain in abdomen ? : Often Sometimes Never
12 Do you have pain in the back ? : Often  Sometimes Never
13 Do you have pain the legs ? : Often  Sometimes Never
14 Do you have cramps in calf muscles ? : Often Sometimes  Never
15 Do you have the problem of burning in soles ? : Often   Sometimes Never
16 Is there any feeling of nausea or vomiting ? : Often  Sometimes   Never
17 Are the menstrual periods regular ? : Yes No
18 Are the menstrual periods painful ? : Yes No
19 Are you presently pregnant ? : Yes No
20 Mention the date of last menses :
21 Have you ever suffered from any miscarriage ? : Yes  No
22 If yes, how many times ? :
23 Was there any child birth after miscarriage ? : Yes No
24 If you have undergone any medical investigations, kindly mention here :
25 Any other problem, which you would like to describe: :
17 Word Verification *  

 
 
   
   
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