QURAN-O-PATHY

QURANIC INSTITUTION OF HEALTH
140 A/1 Gulberg-III, Lahore-Pakistan.
Ph: +92-42-5711859 Mob: +92-342-4400885 Fax:: +92-42-5759844

THE LATEST RESEARCH OF QURAN-OPATHY HAS MADE IT
POSSIBLE TO CURE 100% VIRAL DISEASES ESPECIALLY AIDS.
( THE GOD'S BLESSING)

PATIENT HISTORY FORM

NAME: RESIDENT OF:

AGE: BLOOD GROUP: I.C. NO:

CONTACT #: MOBILE#: FAX#:

E-MAIL: TOLL FREE: WEB ADDRESS:

FAMILY BACK GROUND:

MEDICAL HISTORY:

DOCTOR"S ASSESMENT:

TREATMENT ALREADY DONE:

ANYOTHER TREATMENT:

RESULTS:

 

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