Punsavan Sanskar

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* Required information.
Husband Full Name *
Wife Full Name *
Full Adress *
Contact No.
Email Adress *
Age of Both *
Marriage Date * 1000
Height and Weight (ft-inches./Kg) Both *
What You Using as Contraception * Please select one and for multiple choice, with 'CTRL' & left mousebutton)
Female Side Questions -Duration between two menses *
Last Peroid Date * 1000
Duration of Bleeding in days *
Complications while periods *
Abdominal Pain
Breast Pain
Back Pain
Fever
Leg Pain
Stomatitis
Headache
Other - Specify in detail Query
Other Complications
Any Discharge - White - describe *
Previous pregnancies and delivery details *
Any medication is running now
Male Side - Addiction *
Nothinh
Tobacco
Guthkha
Cigarate
Liquor
Other
Food Type *
Veg
Non-Veg
Both
Occupation
Any Major illness
Any Surgical History
Chicken Pox in Childhood *
Sexual Life *
Good
Average
Erection Problem Sometimes
Lack of Libido
Early Discharge
Night Discharge
Arousal Problem
Excessive Sexual Desire
Your latest Semen report Data *
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