FORM - T
Please Read & Follow the few Guidelines before Filling the measurement form 
 
  • Fill in all the measurements in CENTIMETERS.
  • Take all the measurements on bare skin (i.e. without the clothes).
  • For Length measurements keep the limbs straight.
  • Please enter 10 Digit Patient Mobile No.
  • Please enter Landline No. with STD Code
* Are You a Diabetic Patient?    * Any Diabetic Patient in family?   
Date
*Patient's Name
*Patient's Age *Gender
*Mobile No.
Landline No.
STD Code No.
*Patient's Address

*Pincode
*E-Mail
Doctor's Name
Doctor's Address

Pincode
*Indicated For
Other Indication
Doctor's Email


*Select the Design


(A) Waist Circumference(in cms.)
(B) Height From (A) To Shoulder Blade (in cms.)





Any Additional Information


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