Request New Consultation
Choice of Appointment
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Online
At Parichay Nutri- Gene Clinic
At Dixit Hospital
Available Hours
Busy Hours
Date / Time
Referred By
Hospital/Clinic Name (optional)
Full Name
Postal Address
Age
Gender
Female
Male
Weight (kg)
Height (cm)
Contact Number
Email
Eating Preferences
Veg
Non Veg
Both
Doing Exercise
Yes
No
If yes,how much time , how many time and what type of exercise
How many glasses of water consumed in a day
General complain
Weight gain / Weight loss
Body pain
Fatigue
Leg Pain
Swelling in whole body or face, hands and legs
Breathlessness while walking, Doing work or Climbing stairs
Irregular Menses
Mood swings
Headache
Acidity
Gas
Craving for particular food
Constipation
Diarrhea
Vomiting
Indigestion
Consultation For
Pregnancy Related Problems
Other
Diet in normal pregnancy
Morning sickness and Nausea/Vomiting
Indigestion and heart burn
Belly, pelvic or back pain
Leg cramps
Varicose veins
Urinary tract infections
Itching
Constipation and haemorrhoids
Piles
High blood pressure and pre eclampsia
Thyroid
Anaemia
Gestational diabetes
Polyhydramnios
Oligohydramnios
Pregnancy induced Cholestasis/ Jaundice
IUGR( intrauterine growth restriction)
Hormon Related Problems In Women
Other
Weight Gain
Irregular Periods
Over Growth Of Body And Facial Hair
PCOS/ PCOD
Insulin Resistance
Infertility
Pre Menopausal Symptoms
Menopause
Common GI Problems
Other
IBS
IBD
GERD
Dyspepsia
Peptic Ulcer
Fissure
Biliary Tract Disorder
Gallbladder Disorder
Colitis
Ulcerative Colitis
Crohn's Disease Gallstone
Pancreatitis
Chronic Diarrhea
Hemorrhoids
Celiac Disease
Ulcerative Colitis
Diverticulitis
Anal Fissure
Other
Liver Related Problems
Other
Hepatitis A / B / C / E
Fatty Liver
Cirrhosis of Liver ( Alcoholic / Non Alcoholic )
Jaundice
Other
Cardio Vascular ( Heart Related ) Problem
Other
High cholesterol
High blood pressure
Coronary artery disease
Heart failure
Valvular heart disease
Vascular disease
Deep vein thrombosis
Varicosities
Diabetic foot
Kidney Related Problems
Other
Kidney Stone
Chronic Kidney Disease(CKD)
Glomerulonephritis
UTI
Nephrotic Syndrome
Lung Related Problems
Other
Asthama
COPD
Bronchiectasis
Pulmonary Fibrosis
Other
Other Problems
Other
Over Weight
High Blood Pressure
High Cholesterol
High Uric ACID
High Sugar / Diabetes
Thyroid
TB
Hitus hernia
Arthritis
Rhumetic Arthritis
Osteopenia
Osteoporosis
Cancer
Attach Your Reports & Name Of Medicines With Timing
Reports (optional)
Name Of Medicine With Timing (optional)
Daily Routine & Dietary Plans
(Write time and diet. eg: Food Name at 11AM )
Wake Up Time
Breakfasts Time
Mid Meal
Lunch
Evening snack
Dinner
Bedtime
Notes
* Payment - ₹1100 For Online / ₹700 For Clinic Visit (including 12 Days diet plan)
* Book your appointment before 24 Hrs
* Reschedule your appointment before 2 days
* Appointment cancellation is not available
* Consultation time will be for 30 Minutes only
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