Dear User,

We are happy that you have visited our site to become aware of diabetes and footcare. We strongly appreciate your decision of registering with us. On registering with us you would have the following benefits:

  • You can send it your queries and get clarification for the same.
  • You will be sent regular News letters.
  • You can also fix prior appointment with us through email appointments@mvdiabetes.com

Personal Details
   
Name (in full)
Gender
Age
Nationality
Address
City
State
Country
Pincode
Telephone-1
Telephone-2
Mobile
Fax
 
Diabetic History
   
Duration of Diabetes Years 
Height cms 
Weight kgs 
Treatment type : (insulin / drugs / diet)
Alcohol
Smoking
History of previous foot complication/Allergy
How many times?
Specific foot problems
Name of your family Doctor
 
Upload Details
   
Upload Photo  
Add more
Upload Document  
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Login Details
   
Email (Username)
Password
Re-type Password

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