| 1. |
Are You Married Person? |
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| 2. |
How long are you Married? |
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| 3. |
Do you Have any Child? |
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| 4. |
Is the any history of Chicken pox or Small pox during Childhood? |
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| 5. |
Is there any History of Mumps during Childhood? |
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| 6. |
Do you have a Compliant of Jaundice? |
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| 7. |
Do you have a Compliant of Typhoid? |
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| 8. |
Do you have a Compliant of Tubarculosis? |
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| 9. |
Are you addicted to alchohal, heroin etc...? |
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| 10. |
Are you a Smoker? |
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| 11. |
Do you have both the Tests? |
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| 12. |
Do you have any Compliant of injury in the Testis? |
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| 13. |
Have you got a Compliant of Varicocele, Haematocele, Hydrocele? |
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| 14. |
Have you got the Compliant of Urethritis, Prostatis, Edididymitis, Gonorrhoca, Phimosis? |
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| 15. |
Do you have the Correct size of both Testis?
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16. |
Do you have the Compliant of Semen Discharge during the time of passing Urine (or) Stool?
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17. |
Do you have the Compliant of frequent Semen liak out during night sleep?
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18. |
Do you have nirmal Erection?
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19. |
Do you have Erection in the early morning?
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20. |
About Erection?
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21. |
Do you have interest to do Intercourse?
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22. |
Do you have the Sexual Power to do the Intercourse?
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23. |
Do you have the Compliant of Premature Ejaculation?
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24. |
Do you have the Palpitation during the time of Coitus?
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25. |
Do you have the Compliant of Trembling Sensation of both Limbs During Coitus?
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26. |
Do you any pain from Hip and Leg after passing Seman?
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27. |
Do you have the Compliant of Loss of Memory?
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28. |
Do you have Small Penis?
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29. |
i) What is you Weight?
ii) Are you obese Person?
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30. |
Do you have the Compliant of Blood Pressure (or) Blood Sugar?
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31. |
Do you have the job in hot Environments? |
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