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Private Case Consultation

Please provide accurate details about your age, symptoms, and duration. All personal information and files are kept secure and encrypted.

Your Name (or Alias)

Age (Years)

Country

City

WhatsApp Number (For follow-up)

Marital Status

Select Program Category

Select Specific Condition (Optional)

Specific Concern Type

Skin Sensitivity or Allergy history

Identify Symptoms / Issue Areas

Erection Stiffness Support Premature Ejaculation / Timing Low Desire / Libido General Body Weakness & Fatigue

Do you have Diabetes?

High Blood Pressure?

Is a Semen Report Available?

Married Since (Duration)

Sperm Count (M/ml)

Active Motility (%)

Normal Morphology (%)

Semen Volume (ml)

Problem Duration

Describe Your Symptoms / Issues

Previous Treatment / Medicine Used

Existing Medical Conditions (e.g. Thyroid, Kidney, Stress)

Upload Semen Report or medical slip (Optional)

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