Alternatively please email your information and request for opinion to: ortho.opinion@gmail.com
A recommended format for sending the information is given below. You may however feel free to add any information that you deem necessary. In the interest of privacy, we would request you not to divulge your name, demographics, location. However for communication it is required that you provide us with a preferred username and an email address.
* Marked is mandatory information required to process the request. Please write none if there is no specific information.
Username: Email Id:
Age*: Sex*:
Nature of Compliant* (please give as detailed history as possible in chronological order):
Relevant Past History* (any illnesses in past):
Any relevant Family History*:
Any Allergies*:
Any Addictions*:
Any other relevant Info regarding Patient*:
Blood Investigations*:
Radiographic reports*:
Histopathology reports*:
Diagnosis by your treating physician*:
Past Treatment (listed by generic name)*:
Current Treatment and Future Options advised by your doc (listed by generic name)*:
Specific Reason For Consultation*:
Upload Photos (Can be scanned or digitally photographed):
Any Additional Information:with following information: