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Ba'li Kalari Sangham

Siddha /Ayurvedic Medicine Order Form

Time:

Siddha medicine making image

Please answer the following questions correctly and SUBMIT it or Send details by email without mistakes to enable us to make medicine order quicker. Rates for medicine with courier charges will be informed to you soon. Medicines will reach you within a maximum period of 3 weeks from the date of order for medicines.



Please give details of history of the disease in the textbox below.Also ATTACH and send in my email-ID, scanned details of any medical papers, CT-Scan reports, X-ray reports, urine & blood reports, medicines taken, or currently taking, etc to enable us to make a diagnosis of your problems and to make your Order for Medicine ASAP. Rates for medicine with courier charges will be informed to you soon. There is no IP(In-patients) treatments at our center right now. But you can make an OP(Out-patient) visit if needed.



Your Name:

Your Age :

Married/unmarried:

How many children ?:

Your profession:

Residential Address:

Phone (Landphone or Mobile Number - very essential for courier or cargo services):

Email:


Which disease you are wanting medicine mainly for?:


Any other disease or problems you have like BP/Cardiac/cholestrol/diabetic/Nil?:


From how many years you have the disease?:


Which part of the body you have problems? Previously had any surgery or Nothing? Give details:


Symptoms of disease you feel normally:


Whether taking Allopathic/Ayurveda/Homeopathy or any other medicines till now?:


Give your approximate date of direct visit to us for treatments or consulting:


Specify details whether you want the medicine to be send by courier/parcel service/cargo.
Any Additional Details of Disease you like to mention other than asked above.



Click for Disease-List and its details
My Declaration:


Agree (Recommended for order)
Disagree



Total payable for your medicine: US$: INR:
For eg: you can order medicine for any disease for Rs.5000 or Rs.2500 or Call in my mobile number 09847553600
and confirm price of medicine. Then enter Amount in above Text box and click "BuyNow" button

What Mode of payment would you choose to remit the cost of Kalari
videos?

Cheque in favour of Mathew.P.C in my address
Demand draft in favour of Mathew.P.C in my address
Western Money Transfer or Any Online Bank-Transfer in favour of Mathew.P.C,
Andhra bank a/c no-046010011004203, Chinnakkada, Beach Road, kollam-1, Kerala, India
Bank IFSC code: ANDB0000460
Cash payment - by hand
None of the above




For more suggestions or details to make orders easy give details below







Note: Patients can also visit us directly to our center, have stay or accommodation and get marma-chikitsa treatments & natural Ayurvedic or siddha medicines for any incurable diseases.
Images of lady who came from Madurai, Tamilnadu for cervical problem caused in fall and their Video Testimonial link is given below

Tamil family from Madurai Marma-chikitsa Treatment at Bali kalari Sangham, kollam Marma chikitsa Treatment at Bali kalari Sangham, kollam

Click to see treatment testimonial of Mr.Bhaskaran & his wife Dhanalakshmi


Click here to see 'KALARI','YOGA', 'Ayurveda', 'Siddha' & 'SPIRITUAL GURUS' of Mathew Gurukkal


CONTACT ADDRESS:
MATHEW GURUKKAL, BALI KALARI, OPP: SHINES BLDG, EAST OF IRON-BRIDGE, KOLLAM - 691 001, KERALA STATE, SOUTH-INDIA.
Email: balikalari@playful.com, balikalari@gmail.com, kollammathew@yahoo.co.inMob: No: 91-9847553600, 9746532810, 9847552600
Other sites: http://kalaripat.tripod.com, http://balikalari.tripod.com, http://balikalari.noads.biz
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