Details of your health: Name Address Country Tel Fax E-Mail Age Sex male     female Height cms Weight kg Food habits Mode of work Regular physical activities How is your eye sight? How is your sexual ability? How is your appetite? Do you have constipation regularly? Yes     No How is your Periods (For Female) Any other physical problems you have? Yes     No Any mental stress you have? Yes     No How many year you are suffering from Diabetes? Do you have High BP? Yes     No Did you have the habit of smoking? Yes     No Did you consume liquor? Yes     No Did you like much sweets? Yes     No Did your fore fathers or parents have diabetes? Yes     No Your latest blood and urine sugar reports, What are the medicines you consume at present? Any other health details you want to tell us to get remedy Kindly send us all your health problems

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