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The following information is required about
the patient:
Name: __________________
Age: __________________
Gender: __________________
Resident Country: ______________
City: _________________
Longitude: _____________
Latitude: _______________
Tel. No.:________________
Health Status: ______________
Last medical diagnosis: _________________
Other Diseases (if exist):
____________________
The patient can send his personal photo or
thumb fingertips of the two hands instead of the personal information.
Note: This information will be treated
secretly and confidentially. It will never be available for any official
or non-official parties.
This information can be sent by e-mail to:
[email protected]
When you send the requested data and get the approval for your
treatment, we will send you a schedule of required treatment
sessions.
Falah Mohan
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