AN  ISO 9001:2008 CERTIFIED DISPENSARY

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ENQUIRY FORM

Written by Super User. Posted in main_menu

  • NAME
  • AGE
  • STATUS

MARRIED
UNMARRIED

  • ADDRESS
  • CHIEF COMPLAIN
  • Did you waste semen in early stages ?
 
  • Did you ever suffer from Veneral Disease (V.D.) ?
 
  • do you find your organ (penis) curved or loose of ?
 
  • Does your organ get perfect erection before intercource ?
 
  • Do you feel weakness after intercourse ?
 
  • Do you suffer from early discharge (Premature Ejaculation) ?
 
  • Any other details regarding disease