Kochery Hills - AYURETREAT

Quick Booking

Name:

Mob:

Email:

Date:

Please fill in this form for advice from our doctors.
You can also meet them at Ayuretreat from Monday to Saturday between 10 am and 5 pm (IST).

Name*:
Age:
Sex:	Male Female
Mob*:
Email:
Booking Date:
Chief Complaints (Symptoms):
Duration of the disease:	Months
Other illnesses/ diseases:
Treatment and surgical history:

	*marked fields are mandatory