Our treatment packages are flexible and affordable. Just fill in the treatment form bellow and chose the package that suits you better.

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Case record (will be kept confidential):

[Please Note: If you have already submitted this form, but yet to buy any treatment package or need to extend your treatment package or want to complete your unfinished payment, then you may fill in your Name, Address, Phone/Mobile No and Email Address only, leaving rest of the fields empty and accept the Terms & Conditions of the treatment, to move forward to choose your treatment package and pay for that.]

Name:
Age:
Sex:


Address:
Postal Code:
  Country:
Phone / Mobile No.
Email Address:
Ocupation:
Marital Status:
Main Complaints:
Other Associated Complaints:
History of Present Illness:
Total Duration:
Mode of Onset:
Previously Used Medicine (If possible):
Past History:
Birth History:
History of Mother’s Health During Pregnancy:
History of Diseases Since Birth:
If any of these diseases occurred,- Black fever, Malaria, Typhoid, Measles, Pox, Whooping Cough, Pneumonia, Bronchitis, Tuberculosis, Rheumatic Fever, Arthritis, Hysteria, Epilepsy, Sexually Transmitted Diseases, Skin Diseases, then mention as per age in the table presented bellow.
Diseases
Age
Treatment
Family History:
Paternal side, Maternal side, Husband side any diseases like:
Asthma
Ulcer
Itch
Heart diseases
Diabetes
Fistula
Meningitis
Personal History:
Personal Habits:
Night watching Smoking
Tea Coffee
Alcoholism Pan / Betel-nut
Hobbies:
Book Traveling
Sports Drama Movies
Sexual Function: Sex desire is:
More Less Normal
Male Erection:
Imperfect Loss of Desire
Male Ejaculation:
Delayed Scanty Normal Absent
Menstrual Function: Duration Cycle:
Early
Odour:

Consistency:

Contraception History:

Obstetrical History: Conception History:
Pregnancy
Mental State During Pregnancy:
Leucorrhoea:
Color:
Consistency:
Smell:
Any feeling during Leucorrhoea:
Hot Cold
Generalities: Tendency:
Temperament:
Emotional Weeping Disposition
Anger Irritable Quite
Revengeful Destructive Contradictory
Obstinate Avarice Changeable Mood
Nature of Habits:
Slow Tidy
Dirty Artistic Brooding
Narrative Loquacious Jealous
Suspicious Religious Indecisive
Affectionate Sympathetic Cruel
Rude Proud Romantic
Shy Cowardice Anxious
Anticipatory Restless Startled
Main Mental Features: Desire:
Dancing Drama
Poem Person Animation
Sports Traveling  
Nature:
Calm Quiet Active Habit
Company:
Aversion
Consolation:
Aversion
Disappointment:
Business Ambition Examination
Memory:
Forgetful
Lack of Concentration Confused
Forgetful of Object Names Calculation Difficulty
Fears:
Mental Symptom:
Dreams:

Frequently dreams of:
Desire for Food (like very much):
Food Aversion (dislike very much):
Thirst:
Sweating: Quantity:
Stain on Garment:
Smell:
Sweat on:
Salivation: During Sleep:
Bathing:
Tendency to Take (Catch) Cold:
Fever: Temperature rises pick at
Pick temperature:
Most distressing sensation during fever:
Probable cause of Fever:
Stool: Type:
When does it occur?
Urine:
 

Hereby I declare that I am aware of and agree with all the Terms and Conditions of Treatment at Dr. Sanjay Ray's Multispecialty and Cosmetic Homeo Care.

[If you have a photo, that can help explain your conditions, then please upload it using the form available on Contact Details page.]

Our Homeopathic Treatment Is Easy, Safe & Modern. The Most Successful & Sureshort Treatment Are Done On This Diseases — Acne, Acidity, Artharitis Of Knee & Other Joints, Complexion Fairness, Peptic Ulcer, Spondilitis, High Blood Pressure, High Uric Acid, High Cholesterol & Triglicerides, Back Pain, Sciatica, Knee Pain, Leucorrhoea, Leucoderma, Mouth Ulcer, Obisity, Childrens Disorder, Constipation, Piles, Skin Problem, Pityriasis, Ringworm, Dandruf, Gastritis, Ulcer, Menstrual Disorder, Kidney Cyst, Protein Uria, Overycyst, Tumour, Tonsilities, Urine Infection Repeated, Warts, Whooping Cough, Enlarged Prostate, Etc.

Getting treated is just as easy as 1234...

Treatment Procedure:

  1. Fill up the form correctly in the "Get Treated" section.
  2. Make payment online through PayPal or deposit the amount directly in the mentioned Bank Account.
  3. Send an confirmation email along with all payment details, if you chose to deposit the amount directly into the bank account.
  4. Dr. Sanjay Ray will contact you over email in case any further information is required for the treatment.
  5. You can also contact him through email or talk directly over telephone or chat online within fixed hours to eliminate any doubt you might have.
  6. Get the medical advice along with the medicine package through courier or medical advice only, depending on the treatment package you chose.