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Clients identification

The fields with the sign * are required the rest are optional.

*Name
*Age
Sex	Male Female
*Height
*Weight	Kgs
City
Zip Code
*Country
*Tel
*Email

Do you have following test reports If yes then type the conclusions

Thyroid scan report/print
Serum T3, T4, TSH
Ultra sound of neck
Urinary iodine level
* Comments ...... History of diseases...!

Goiter Cure Homeopathic Clinic

Dr. Ali Amin M .S c , D.H. M .S (N.C.H)
Mobile: +92-3336702186
REGD.NO, 36907
Dr. Aziz Ali Road , Chiniot-35400,Pakistan.
Email: aliamindr@yahoo.com
Web Site: http://www.goiter.com.pk