We'll be asking a few questions so your doctor can find the best treatment for you. This quiz is short and sweet, and confidential between you and your doctor.
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Please make sure your email address is correct
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Please Provide Your Valid phone Number
By providing your phone number, you are giving us permission to reach you through SMS or WhatsApp.
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Infertility?
Primary
Secondary
Duration of Infertility in Months
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Previous Investigation(s) or treatment for Infertility
Neurologic diesease
Other
History of medical treatment
No
Diabetes
Tuberculosis
Chronic respiratory tract disease
fibrocystic diesease of the pancress
Neurologic diesease
Other
High fever in last months
No
Yes
History of Surgery
No
Yes
Please explain for the doctor.
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History of Urinary Infection
No
Yes
History of Sexually Transmitted diesease
No
Yes
Please explain for the doctor.
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History of epididymitis
No
Yes
Wich side of epididymitis
Right
Left
History of Pathology possibly causing testicular damage
Yes
No
History of varicocele treatment
Yes
No
History of testicular maidescent
Yes
No
Treatment for testicular maidescent
None
Medical
Surgical
What was Your age in Years at time of treatment
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Environment and/or occupational factor
No
Heal
Toxic Factor
Others
Please explain Environment and/or occupational factor for the doctor
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Excess consumption of alcohol or drug abuse
No
Yes
Average frequency of virginal intercourse per month
Normal
Inadequate
Erection Problem
Normal
Inadequate
Ejaculation Problem
Normal
Inadequate
Do you want to provide additional details that can help your doctor understand you better?
No
Yes
Please share them here...
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Payment for Online Consultation
Information
First Name
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Last Name
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Phone Number
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House No
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City
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Postal Code
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Payment Information
DATE
3/14/2025
ORDER NUMBER
1721758501
STORE NAME
Medgic.pk
AMOUNT FOR CONSULATION
Rs/- 1500.00 Only
SUMMARY
Online Consultation Fee
Proceed to checkout Rs/- 1500*
