Name
	Age
	Sex    M    F           Height
	Weight
	Chest  measure

	Shoulder  width                      Abdominal  measure
	Waist
	Hip measure
	Length  of  thigh ( Groins to top of  knee )
	Length of  leg ( lower of  knee to top of ankle )
	Length  of  foot               Normal / flat foo
	Problems  faced
	Spondelitise      Scapulitise       Pain in wrist      Stiffness and numb ness of fingers
	Stiffness of back      Pain in lower back       Pain in hip joint       Pain  in knees      Pain in ankles
	Pain in heels      Pain  in toes
	Other  health  troubles
	Type  of  occupation            Hours  of  working
	Hobbies
	Vehicle  you  drive /  you  travel
	Payment Details
	Name
	Address
	e-mail ID
	Chq / pay order / draft no               Dated
	Rs/-
	Please deposit  fees  of Rs/- 3000 only by  chq./ pay order draft  to the account of  R.S. Buche, SBI  core banking account no- 30066166230, SBI south Guwahati branch Guwahati.