Make your own free website on


Online Consultancy- Patient Form

Home | About Homeopathy | Meet Dr. Patel | Online Consultancy | Human Health & Diseases | Contact Us | Order Homeopathy Products | Patients' Feedback

Please ensure that you fill in accurate information, so that we can serve you to the best of our abilities

Note- All fields are mandatory

First Name
Last Name
Age (in years)
Email Address
Postal/ Mail Address
Mode of PaymentSBI Swift Transfer Mode
Western Union Money Transfer
Demand Draft
Describe your Medical Condition
Your current therapy & medication for the condition
Mention Allergies, if any.

Terms of use: The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician. Information and opinions expressed on this website may be those of the doctor who has written them on the base of her education and experiences.

The information provided should be examined in the light of individual case evaluation. The website developers and Dr. Kashmira Patel take no responsibility whatsoever of the consequences experienced by the patients who may use the information provided on this website. Dr.Patel assures you of the best possible efforts for those who apply for online treatment. However, please note that no claim is made to cure each and every case, nor is any magical cure guaranteed. The homeopathic medicines are essentially free from side effects. We takes no responsibility for any presumed complications. It is considered that the user has read and agreed to this disclaimer, when one uses the literature on this site and the online treatment option.