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Patient’s Complete Name

Contact Number

Date of Submission

Relationship with Patient

Write us Three to Five (3-5) Chief Presenting Medical Complaints of the Patient

Give us the Past Medical History about these Complaints (When & How they happened?)

Elaborate Significant Past Medical Illness & / or Past / Current Medication

M. Bin Tariq
Consultant Eastern Medicine
BEMS Hamdard University

Deals in: Natural & Holistic Treatments