Dear Patron,

While many of our medicines can be taken as directed by your physician, there are instances where they are combined with other ingredients such as Jeera Churna, Moukika Bhasma, Talisadhi Churna, and so forth. This is done to tailor the dosages based on specific ailments. To ensure transparency and that you receive what you've paid for, we typically send the empty bottles alongside the prepared dosage packets.

For the most accurate medical advise, kindly complete the entire form. We commit to addressing your questions within 24 to 48 hours. Rest assured, all consultations will be directly managed by our Chief Physician. For further details, please visit www.vanchintaluru.com.

Full Name *

Mobile Number *

Email ID *

Address *

Town / City *

Pin Code *

Country *

State *

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

Are you a diabetic? *

Since when you are a diabetic? (Answer '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 'NO' if you are a non-diabetic) *

Is there a diabetic in your family tree? *

Your Gender? *

Your age? *

Your Height *

Your Weight (in Kgs) *

Your Occupation *

Are you a Vegetarian or Non Vegetarian? *

Do you consume alcohol? *

Are you a smoker? *

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

Do you suffer from high blood pressure? *

Systole*

Diastole*

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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