SlideShare a Scribd company logo
1 of 1
Download to read offline
R_prelim_app_Rev6_SVM_040313 visit www.ihhp.net for details - mail Id:: ihhp.blr@gmail.com 
IIHCC Ref 
WS 
Patient ID 
App. Ref 
Habits : Non-Veg [ ] Alcohol [ ] Tobacco/Gutka [ ] Egg [ ] (  check all that are applicable) 
Any Other : 
A. Patient Details 
1 
Name 
5a 
Address 
2a 
Date Of Birth 
2b 
Time Of Birth 
2c 
Place Of Birth 
5b 
City 
3a 
Phone LL 
5c 
State 
3b 
Mobile 1 
5d 
Pin Code 
3c 
Mobile 2 
6 
Referred by 
4 
E mail ID 
7 
Qualification / 
Profession 
B. Details of Ailments (latest First) C. Patient Declaration 
(Use Reverse Side / Separate sheet if required) 
No 
Disease Name 
Since Date 
No 
Medicines Taken 
Dosage 
International Integrated Holistic Cure Centre (IIHCC) 
No 95, 8th Cross, 20th Main, G Block, Sahakar Nagar, Bangalore 560 092 
FTR Therapy - Preliminary Registration Form 
1. I hereby voluntarily consent to be treated by FTR ( Finger Tip Revolution ) and/or equivalent Herbal medicines derived by FTR method and prepared Homoeopathically suggested by IIHCC Free Medical Consultant. 
2. I understand that FTR is to be done by myself with my own finger tips as advised by IIHCC Free Medical Consultant, in an attempt to improve the body function and/or relieve pain. 
3. I acknowledge that no side effects would be possible, as it involves my own finger tips and/or the equivalent Homoeo medium potency (3X to 12X) medicines. 
4. I accept the fact that no guarantee is made concerning use of FTR and/or equivalent suggested medicines. 
5. I understand that may stoop treatment at any time. 
6. I acknowledge the fact that IIHCC Free Medical Consultant does not profess to be western-trained medical doctor and does not advice on the use of medically prescribed pharmaceuticals or medical treatment, nor does the IIHCC Free Medical Consultant give any substances by injection. 
7. I received completely free consultancy (no consultation fees). 
8. The clinical data gathered in practice, without names, may be used for statistical research and teaching purposes. 
9. I have been asked not to discontinue my present medication. 
For IIHCC use only 
Prescription 
Please Affix 
Photo here 
Important Note: 
It is a Pre-requisite for undergoing “FTR 
Process” that the Beneficiary should totally abstain 
from any kind of Non-Vegetarian Food including 
Egg. I am aware of the above. 
All above data are given at my free will and I approached the ashram on my own for my ailment. 
Sign 
here 
Name: 
Date:

More Related Content

What's hot

Health Suraksha Health Insurance Claim Form - HDFC ERGO
Health Suraksha Health Insurance Claim Form - HDFC ERGOHealth Suraksha Health Insurance Claim Form - HDFC ERGO
Health Suraksha Health Insurance Claim Form - HDFC ERGOSaurav Mishra
 
Indian Pharmacy act 1940 and 1945
Indian Pharmacy act 1940 and 1945Indian Pharmacy act 1940 and 1945
Indian Pharmacy act 1940 and 1945Tanmay Patel
 
Why did d-penicillamine disappear from the market?
Why did d-penicillamine disappear from the market?Why did d-penicillamine disappear from the market?
Why did d-penicillamine disappear from the market?Sanjeev Kumar
 
Oe 2018.03 pp
Oe 2018.03 ppOe 2018.03 pp
Oe 2018.03 ppleapimg
 

What's hot (9)

Health Suraksha Health Insurance Claim Form - HDFC ERGO
Health Suraksha Health Insurance Claim Form - HDFC ERGOHealth Suraksha Health Insurance Claim Form - HDFC ERGO
Health Suraksha Health Insurance Claim Form - HDFC ERGO
 
What is immigration physical
What is immigration physicalWhat is immigration physical
What is immigration physical
 
Indian Pharmacy act 1940 and 1945
Indian Pharmacy act 1940 and 1945Indian Pharmacy act 1940 and 1945
Indian Pharmacy act 1940 and 1945
 
Clalit haifa
Clalit haifaClalit haifa
Clalit haifa
 
Why did d-penicillamine disappear from the market?
Why did d-penicillamine disappear from the market?Why did d-penicillamine disappear from the market?
Why did d-penicillamine disappear from the market?
 
Mtp dr. sharda jain
Mtp dr. sharda jainMtp dr. sharda jain
Mtp dr. sharda jain
 
Oe 2018.03 pp
Oe 2018.03 ppOe 2018.03 pp
Oe 2018.03 pp
 
Mtp%20 act
Mtp%20 actMtp%20 act
Mtp%20 act
 
Prescription ppt
Prescription pptPrescription ppt
Prescription ppt
 

Similar to Registration ftr

Sudipt Rath_Udpr_12.10.19.pptx
Sudipt Rath_Udpr_12.10.19.pptxSudipt Rath_Udpr_12.10.19.pptx
Sudipt Rath_Udpr_12.10.19.pptxAyuprad Soni
 
Health Care Proxy
Health Care ProxyHealth Care Proxy
Health Care ProxyHealth Care
 
Justifiable abortion (therapeutic abortion)
Justifiable abortion (therapeutic abortion)Justifiable abortion (therapeutic abortion)
Justifiable abortion (therapeutic abortion)Dr. FAIZ AHMAD
 
Bioethics- Case study on Autonomy and Decision making in medicine
Bioethics- Case study on Autonomy and Decision making in medicineBioethics- Case study on Autonomy and Decision making in medicine
Bioethics- Case study on Autonomy and Decision making in medicineavi sehgal
 
medicalterminationofpregnancyact1971-211124071122.pdf
medicalterminationofpregnancyact1971-211124071122.pdfmedicalterminationofpregnancyact1971-211124071122.pdf
medicalterminationofpregnancyact1971-211124071122.pdfDarshanpatel609504
 
Medical termination of pregnancy act 1971
Medical termination of pregnancy act 1971Medical termination of pregnancy act 1971
Medical termination of pregnancy act 1971Ashish Chaudhari
 
forensic medicine and Medical ethics
forensic medicine and Medical ethicsforensic medicine and Medical ethics
forensic medicine and Medical ethicsSylvia Seeralan
 
Indian medical council act
Indian medical council actIndian medical council act
Indian medical council actARUNAYESUDAS
 
Drugs and magic remedies act (objectionable advertisements) 1954
Drugs and magic remedies act (objectionable advertisements) 1954Drugs and magic remedies act (objectionable advertisements) 1954
Drugs and magic remedies act (objectionable advertisements) 1954Sanchita Mahale
 
informed consent in research (Prof. Oamr Kasule)
informed consent in research (Prof. Oamr Kasule)informed consent in research (Prof. Oamr Kasule)
informed consent in research (Prof. Oamr Kasule)Dr Ghaiath Hussein
 
Sickness & fitness certificate
Sickness &  fitness certificateSickness &  fitness certificate
Sickness & fitness certificateASHUTOSH POTDAR
 
Medical release form
Medical release formMedical release form
Medical release formMohamed Zaki
 
Approaches To Issues Of Futility
Approaches To Issues Of FutilityApproaches To Issues Of Futility
Approaches To Issues Of FutilityBernard Freedman
 
Patient Consent
Patient ConsentPatient Consent
Patient ConsentNc Das
 
PATIENT’S BILL OF RIGHTS Philippine setting.pptx
PATIENT’S BILL OF RIGHTS Philippine setting.pptxPATIENT’S BILL OF RIGHTS Philippine setting.pptx
PATIENT’S BILL OF RIGHTS Philippine setting.pptxkristinecruz30
 

Similar to Registration ftr (20)

Legal rights of a patient
Legal rights of a patientLegal rights of a patient
Legal rights of a patient
 
Medical records
Medical recordsMedical records
Medical records
 
Sudipt Rath_Udpr_12.10.19.pptx
Sudipt Rath_Udpr_12.10.19.pptxSudipt Rath_Udpr_12.10.19.pptx
Sudipt Rath_Udpr_12.10.19.pptx
 
Health Care Proxy
Health Care ProxyHealth Care Proxy
Health Care Proxy
 
Justifiable abortion (therapeutic abortion)
Justifiable abortion (therapeutic abortion)Justifiable abortion (therapeutic abortion)
Justifiable abortion (therapeutic abortion)
 
Bioethics- Case study on Autonomy and Decision making in medicine
Bioethics- Case study on Autonomy and Decision making in medicineBioethics- Case study on Autonomy and Decision making in medicine
Bioethics- Case study on Autonomy and Decision making in medicine
 
medicalterminationofpregnancyact1971-211124071122.pdf
medicalterminationofpregnancyact1971-211124071122.pdfmedicalterminationofpregnancyact1971-211124071122.pdf
medicalterminationofpregnancyact1971-211124071122.pdf
 
Medical termination of pregnancy act 1971
Medical termination of pregnancy act 1971Medical termination of pregnancy act 1971
Medical termination of pregnancy act 1971
 
PATIENTS BILL OF RIGHTS
PATIENTS BILL OF RIGHTSPATIENTS BILL OF RIGHTS
PATIENTS BILL OF RIGHTS
 
forensic medicine and Medical ethics
forensic medicine and Medical ethicsforensic medicine and Medical ethics
forensic medicine and Medical ethics
 
Indian medical council act
Indian medical council actIndian medical council act
Indian medical council act
 
Drugs and magic remedies act (objectionable advertisements) 1954
Drugs and magic remedies act (objectionable advertisements) 1954Drugs and magic remedies act (objectionable advertisements) 1954
Drugs and magic remedies act (objectionable advertisements) 1954
 
informed consent in research (Prof. Oamr Kasule)
informed consent in research (Prof. Oamr Kasule)informed consent in research (Prof. Oamr Kasule)
informed consent in research (Prof. Oamr Kasule)
 
Sickness & fitness certificate
Sickness &  fitness certificateSickness &  fitness certificate
Sickness & fitness certificate
 
Medical release form
Medical release formMedical release form
Medical release form
 
Refusal of care.pptx
Refusal of care.pptxRefusal of care.pptx
Refusal of care.pptx
 
Approaches To Issues Of Futility
Approaches To Issues Of FutilityApproaches To Issues Of Futility
Approaches To Issues Of Futility
 
Patient Consent
Patient ConsentPatient Consent
Patient Consent
 
Living will - Doccare Medical Clinic
Living will - Doccare Medical ClinicLiving will - Doccare Medical Clinic
Living will - Doccare Medical Clinic
 
PATIENT’S BILL OF RIGHTS Philippine setting.pptx
PATIENT’S BILL OF RIGHTS Philippine setting.pptxPATIENT’S BILL OF RIGHTS Philippine setting.pptx
PATIENT’S BILL OF RIGHTS Philippine setting.pptx
 

More from Roopa slideshare (20)

Magnet basics
Magnet basicsMagnet basics
Magnet basics
 
what_is_science.pdf
what_is_science.pdfwhat_is_science.pdf
what_is_science.pdf
 
What is science
What is scienceWhat is science
What is science
 
roo-OB-PicklistMultiSelect
 roo-OB-PicklistMultiSelect roo-OB-PicklistMultiSelect
roo-OB-PicklistMultiSelect
 
AQ
AQAQ
AQ
 
Presentations-Tips.ppt
Presentations-Tips.pptPresentations-Tips.ppt
Presentations-Tips.ppt
 
Std10-Maths-EM-1.pdf
Std10-Maths-EM-1.pdfStd10-Maths-EM-1.pdf
Std10-Maths-EM-1.pdf
 
slide.txt
slide.txtslide.txt
slide.txt
 
new.pptx
new.pptxnew.pptx
new.pptx
 
Empty
EmptyEmpty
Empty
 
new.pptx
new.pptxnew.pptx
new.pptx
 
slide.txt
slide.txtslide.txt
slide.txt
 
slide1.rtf
slide1.rtfslide1.rtf
slide1.rtf
 
Std10-Maths-EM-1.pdf
Std10-Maths-EM-1.pdfStd10-Maths-EM-1.pdf
Std10-Maths-EM-1.pdf
 
Std10-Maths-EM-1.pdf
Std10-Maths-EM-1.pdfStd10-Maths-EM-1.pdf
Std10-Maths-EM-1.pdf
 
this is USer
this is USerthis is USer
this is USer
 
Daily inspiration
Daily inspirationDaily inspiration
Daily inspiration
 
Empty
EmptyEmpty
Empty
 
New
NewNew
New
 
slide.txt
slide.txtslide.txt
slide.txt
 

Recently uploaded

Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
Dehradun Call Girls 8854095900 Call Girl in Dehradun  UttrakhandDehradun Call Girls 8854095900 Call Girl in Dehradun  Uttrakhand
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhandindiancallgirl4rent
 
Nanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Nanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetNanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Nanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh
💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh
💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In ChandigarhSheetaleventcompany
 
Top 20 Famous Indian Female Pornstars Name List 2024
Top 20 Famous Indian Female Pornstars Name List 2024Top 20 Famous Indian Female Pornstars Name List 2024
Top 20 Famous Indian Female Pornstars Name List 2024Sheetaleventcompany
 
Patna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Patna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetPatna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Patna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
raisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
raisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetraisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
raisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...mahaiklolahd
 
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetThrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
Russian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near Me
Russian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near MeRussian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near Me
Russian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near Memriyagarg453
 
bhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
bhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetbhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
bhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
Ernakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ernakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetErnakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ernakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Chandigarh
 
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetHubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
Rajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Rajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetRajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Rajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
Kochi call girls Mallu escort girls available 7877702510
Kochi call girls Mallu escort girls available 7877702510Kochi call girls Mallu escort girls available 7877702510
Kochi call girls Mallu escort girls available 7877702510Vipesco
 
nagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
nagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetnagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
nagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetCall Girls Service
 
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Jaipur Call Girls 9257276172 Call Girl in Jaipur RajasthanJaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthanindiancallgirl4rent
 
Best Lahore Escorts 😮‍💨03250114445 || VIP escorts in Lahore
Best Lahore Escorts 😮‍💨03250114445 || VIP escorts in LahoreBest Lahore Escorts 😮‍💨03250114445 || VIP escorts in Lahore
Best Lahore Escorts 😮‍💨03250114445 || VIP escorts in LahoreDeny Daniel
 
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...Ahmedabad Call Girls
 
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girlKolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girlonly4webmaster01
 

Recently uploaded (20)

Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
Dehradun Call Girls 8854095900 Call Girl in Dehradun  UttrakhandDehradun Call Girls 8854095900 Call Girl in Dehradun  Uttrakhand
Dehradun Call Girls 8854095900 Call Girl in Dehradun Uttrakhand
 
Nanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Nanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetNanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Nanded Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh
💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh
💚 Punjabi Call Girls In Chandigarh 💯Lucky 🔝8868886958🔝Call Girl In Chandigarh
 
Top 20 Famous Indian Female Pornstars Name List 2024
Top 20 Famous Indian Female Pornstars Name List 2024Top 20 Famous Indian Female Pornstars Name List 2024
Top 20 Famous Indian Female Pornstars Name List 2024
 
Patna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Patna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetPatna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Patna Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
raisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
raisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetraisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
raisen Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
Call Girl in Bangalore 9632137771 {LowPrice} ❤️ (Navya) Bangalore Call Girls ...
 
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetThrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Thrissur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Russian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near Me
Russian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near MeRussian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near Me
Russian Call Girls in Noida Pallavi 9711199171 High Class Call Girl Near Me
 
bhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
bhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetbhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
bhubaneswar Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
ooty Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Ernakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ernakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetErnakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Ernakulam Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetHubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Hubli Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Rajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Rajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real MeetRajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Rajkot Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Kochi call girls Mallu escort girls available 7877702510
Kochi call girls Mallu escort girls available 7877702510Kochi call girls Mallu escort girls available 7877702510
Kochi call girls Mallu escort girls available 7877702510
 
nagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
nagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meetnagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
nagpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
 
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Jaipur Call Girls 9257276172 Call Girl in Jaipur RajasthanJaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
Jaipur Call Girls 9257276172 Call Girl in Jaipur Rajasthan
 
Best Lahore Escorts 😮‍💨03250114445 || VIP escorts in Lahore
Best Lahore Escorts 😮‍💨03250114445 || VIP escorts in LahoreBest Lahore Escorts 😮‍💨03250114445 || VIP escorts in Lahore
Best Lahore Escorts 😮‍💨03250114445 || VIP escorts in Lahore
 
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
(Deeksha) 💓 9920725232 💓High Profile Call Girls Navi Mumbai You Can Get The S...
 
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girlKolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
Kolkata Call Girls Miss Inaaya ❤️ at @30% discount Everyday Call girl
 

Registration ftr

  • 1. R_prelim_app_Rev6_SVM_040313 visit www.ihhp.net for details - mail Id:: ihhp.blr@gmail.com IIHCC Ref WS Patient ID App. Ref Habits : Non-Veg [ ] Alcohol [ ] Tobacco/Gutka [ ] Egg [ ] (  check all that are applicable) Any Other : A. Patient Details 1 Name 5a Address 2a Date Of Birth 2b Time Of Birth 2c Place Of Birth 5b City 3a Phone LL 5c State 3b Mobile 1 5d Pin Code 3c Mobile 2 6 Referred by 4 E mail ID 7 Qualification / Profession B. Details of Ailments (latest First) C. Patient Declaration (Use Reverse Side / Separate sheet if required) No Disease Name Since Date No Medicines Taken Dosage International Integrated Holistic Cure Centre (IIHCC) No 95, 8th Cross, 20th Main, G Block, Sahakar Nagar, Bangalore 560 092 FTR Therapy - Preliminary Registration Form 1. I hereby voluntarily consent to be treated by FTR ( Finger Tip Revolution ) and/or equivalent Herbal medicines derived by FTR method and prepared Homoeopathically suggested by IIHCC Free Medical Consultant. 2. I understand that FTR is to be done by myself with my own finger tips as advised by IIHCC Free Medical Consultant, in an attempt to improve the body function and/or relieve pain. 3. I acknowledge that no side effects would be possible, as it involves my own finger tips and/or the equivalent Homoeo medium potency (3X to 12X) medicines. 4. I accept the fact that no guarantee is made concerning use of FTR and/or equivalent suggested medicines. 5. I understand that may stoop treatment at any time. 6. I acknowledge the fact that IIHCC Free Medical Consultant does not profess to be western-trained medical doctor and does not advice on the use of medically prescribed pharmaceuticals or medical treatment, nor does the IIHCC Free Medical Consultant give any substances by injection. 7. I received completely free consultancy (no consultation fees). 8. The clinical data gathered in practice, without names, may be used for statistical research and teaching purposes. 9. I have been asked not to discontinue my present medication. For IIHCC use only Prescription Please Affix Photo here Important Note: It is a Pre-requisite for undergoing “FTR Process” that the Beneficiary should totally abstain from any kind of Non-Vegetarian Food including Egg. I am aware of the above. All above data are given at my free will and I approached the ashram on my own for my ailment. Sign here Name: Date: