Shree Varma - Online Consultation Form

Shreevarma Bio Naturals - Online Consultation Form

You must fill the form after you have purchased any of the Online Treatment packages. If you have already purchased a treatment package from us, please ignore this message and thanks for the purchase

  • Please enter your Date of Birth here

  • Enter your Age here

  • Choose your Gender

  • Choose your Marital Status

  • Please enter your Address for Communication here.

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    Please enter your Phone.No here

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    Please enter your Mobile.No here

  • Please enter your Qualification here

  • Please enter your Occupation here

  • How you come to know about Shreevarma?

  • Have you done Yoga before?

  • If yes, mention the type of Yoga you have done:

  • Do you practice Yoga daily?

  • Mention no.of hours per day.

  • Do you wish to join Diploma in Self Healing course? *

  • Present complaints with time period:

  • Associated complaints:

  • Past history of any disease:

  • Any of your family member is suffering from the above disease?

  • Any History of Surgery:

  • Present medications if any:

  • Who is your family Physician? (Name & Address)

  • Mention your Diet

  • Mention your Appetite here

  • If Constipation, mention days

  • If Diarrhoea, mention times in a day

  • Mention Stool consistency

  • How many hours of sleep (in hrs per day)

  • Do you take sleeping pills?

  • Colour of urine:

  • If yes, mention hours in a day