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Or else,please fill up the below form and send it to us-

 STRIDE Patient Registration Form-

1) Name:
2) Age:
3) Sex:
4) Marital Status:
5) Veg / Non-vegeterian:
6) Where is the problem:
7) Since how many days you are suffering from the problem:
8) How much is your pain level out of 10 ?(10 is the maximum pain level): 1
2
3
4
5
6
7
8
9
10
9) Have you met any Doctor or Physio for your problem :
10) Earlier have you taken any Physiotherapy treatment for the same problem :
11) Taking any medicines for your problem?(Please write the medicine name) :
12) Patient's height (in cm):
13) Patient's weight (in kg):
14) Occupation :
15) How do you know about STRIDE :
16) Email Address:
17) Mobile number:
18) Your full Postal address for our Service :

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