PSYCHIATRIC CONSULT ONLINE...

Below is the online consultation form, which you have to fill and submit the Information required box along with  Psychiatric Querry you want to get answered.

Your Querry will be answered within 3 working days of receiving the querry.

You will have to pay INR 500 in my ICICI Bank Account No-

004301027277 

For querries from abroad you have to Deposit USD 50 in the account .

Name

 AGE           

SEX

ADDRESS                       

EMAIL

NATURE OF WORK 

HOURS OF WORKING

MARRIED                                                             

IF YES SINCE WHEN

NO OF CHILDREN

ANY SUBSTANCE DEPENDENCE-

PAST HISTORY OF ANY PSYCHIATRIC ILLNESS AND TREATMENT [ IF YES-GIVE DETAILS]

DETAILS OF CURRENT PSYCHIATRIC ILLNESS==

-- MENTION THE SYMPTOMS

---DURATION....

---ANY  TEATMENT  TAKEN AND ITS RESULTS.

--CURRENT MEDICATIONS YOU ARE TAKING.

---ENTER ANY OTHER RELEVANT INFORMATION YOU FEEL IS IMPORTANT

--MEDICAL ILLNESS YOU ARE SUFFERING FROM