Venkateswara Ayurveda Nilayam Ltd (Since 1925) Online Doctor Consultation Form (Please fill the entire form for better medical advise)

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We will respond back for all your queries within 24 to 48 hours. All consultations will be personally handled by our Chief Physician. For more information please visit www.VanChintaluru.Com.

Dear Patron,

Most of our medicines can be consumed as instructed by the physician but sometimes we have to make them as a mix along with few other ingredients like Jeera Churna / Moukika Bhasma / Talisadhi Churna and etc products and make them into dosage packets as per ailment (disease). In this case, we normally ship the emptied bottles along with the dosage packets to make sure that we used the products which you have paid for to make them into dosages.

Team
VAN Ltd

Enter your full name *

Your email Id *

Mobile number *

Address (Line One) *

Address (Line Two)

City Name *

Postal Pin code *

State *

Country *

Type in your health issues and specify if you are using any other medicines at present *

Are you a diabetic? *

If yes then since when you are a diabetic? (10 years, 2 years etc). (Answer as NO if you are a non-diabetic) *

If yes then provide your sugar levels on fasting and post lunch (Please provide the readings within the last one week for better medical advise). (Answer as NO if you are a non-diabetic) *

Is there a diabetic in your family tree? *

Yes

Your Age *

Gender *

Your Height (5.6, 5.9 feet etc) *

Your Weight (in Kgs) *

Your Occupation *

Are you a Vegetarian or Non Vegetarian? *

Consume Alcohol? *

Are you a smoker? *

Any other forms of tobacco? (Gutkha / Khaini etc) *

Do you suffer from high blood pressure, if so what is your cystolic and diastolic readings? *

Are you suffering from any liver disorders ? If yes please specify *

Have you undergone any major surgery ? If yes please provide more details on the surgery details. Like type of surgery and how many years back its been done. *

Any other health complaints (or) disorders if you or anyone in your family history please provide details here. If you have more than one complication please mention all of them with number of years you are suffering from. *

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