Enquiry Form

* marked are mandatory sections.Our Customer Care executives will contact you within 12 hours.

Name *

Surname *

Enter your email *

Enter your contact number *

Skype

Postal Address *

City *

Country *

ZIP/Postal Code *

Fax

Have you been to INDIA

Preferred online consultation mode

Type of medical disease/disorder

Please specify the medical assistance you need along with medical history and current Medication. *

Medical report and prescription (optional) can be sent directly on [email protected] mentioning your name.