Demande d’informations

This form is for the doctor of our Ayurvedic treatment center.
The data it contains are completely confidential and are not retained.
Furthermore we guarantee that no use of any kind and for any reason, shall be made with the data contained in this form.
We also guarantee that such information may not be sold under any pretext or reason.
This information is intended for the exclusive use of our doctor and their content is covered by the confidentiality obligation.

Please fill in the required fields below and one of our program. Consultants will contact you shortly.
If you'd like to speak to a person right now, call :
(+91) 413 26 56 351 | (+91) 413 29 12 280 | (+91) 413 29 12 288 | (+91) 936 44 55 440.

Guest services receptionists are available between the hours of 7 a.m. to 7 p.m. (India time -4,5 Hrs) from Monday to Sunday

Gender *

MrsMsMrMissMasterDrLordladyRevProfCaptSir

First name *

Last name *

Age *

Email *

I am interested in the following programs:* You can select one or more programs

You can select one or more programsDetoxification Program / Panchakarma ChikitsaRejuvenation Program / Rasayana ChikitsaAnti Stress Program / ManashantiSlimming Program / Lekhaneeyam ChikitsaBeauty Care Program / Soundarya ChikitsaMagic Water PackagesDisease management / Aturasya Vyadhi Parimokshanam

I'm suffering of the following pathologies: You can select one or more programs

—Veuillez choisir une option—Rheumatoid arthritisOsteoarthritisMusculo skeletal diseasesNeurological diseasesSkin DiseasesMetabolic DisordersCardiovascular Disorders.

Country (mandatory)

Subject

What would you us to take care of??

Describe what care you want and for what diseases you need to treat. Enter your allergies, current treatments. Tell us what you think helpful for us to know to prepare the best personalized response.