Please share some basic info

as per medical guideline and visible only to doctors

Basic Patient Info

Preferred Sexologist Gender

Preferred Treatment

Explain in Details

*Maximum 3 files can be uploaded
*Only JPG/JPEG/PNG/PDF allowed
*Maximum size 1 MB for each file

Additional Details

Do you have any previously diagnosed condition ?

Do you take Medication ?

Do you have any Allergies ?

Do you drink ?