Treatment Paid 5 $ (Doller)or (400 Tk Bangladesh )

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Treatment Paid 5 $ (Doller)or (400 Tk Bangladesh )

bkash Personal 01722 13 82 59

Sign in to Google to save your progress. Learn more

* Indicates required question

ALL OF THOSE DISEASES ARE TREATED

Name : *

Your answer

Age : *

Your answer

Email :

Your answer

Address : *

Your answer

Phone number : *

Your answer

Main Problem ; *

Your answer

Disease Descriptions :

Your answer

Others Problems :

Your answer

Here Likes ;

Hot

Cold

Likes all

Not at all

Comments

Your answer

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy