Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone Numbers *Select date of appointment *12345678910111213141516171819202122232425262728293031Month *JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear *20212022Please select your State of residenceAbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEdoEkitiEnuguFederal Capital TerritoryGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfaraPlease select your treatment *- Please select -Prostrate IssuesKidney IssuesGeneral MedicinePlease explain what you want *Submit
