{"id":16088,"date":"2021-10-23T07:13:48","date_gmt":"2021-10-23T07:13:48","guid":{"rendered":"https:\/\/sulemani.com.pk\/new\/?page_id=16088"},"modified":"2026-08-03T03:24:01","modified_gmt":"2026-08-03T03:24:01","slug":"diseases-of-men","status":"publish","type":"page","link":"https:\/\/sulemani.com.pk\/en\/diseases-of-men\/","title":{"rendered":"Diagnostic form for men"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"16088\" class=\"elementor elementor-16088\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"wd-negative-gap elementor-element elementor-element-fba4c2b e-flex e-con-boxed e-con e-parent\" data-id=\"fba4c2b\" data-element_type=\"container\" data-e-type=\"container\" data-no-translation=\"\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3ce1fb5 elementor-widget elementor-widget-shortcode\" data-id=\"3ce1fb5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f21549-o2\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"21549\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/16088#wpcf7-f21549-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"21549\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f21549-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"men-health-cf7\" dir=\"ltr\">\n\t<div class=\"cf7-form-hero\">\n\t\t<p><span class=\"cf7-badge\">For Men<\/span>\n\t\t<\/p>\n\t\t<h2>Men's Diagnostic Form\n\t\t<\/h2>\n\t\t<p>Please provide complete and accurate information so that your condition can be assessed properly and appropriate guidance can be provided.\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"cf7-section\">\n\t\t<h3>Basic Information\n\t\t<\/h3>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label>Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter your full name\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Father's Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"father-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter your father&#039;s name\" value=\"\" type=\"text\" name=\"father-name\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Age<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" min=\"10\" max=\"100\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Age in years\" value=\"\" type=\"number\" name=\"age\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Date<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"form-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"form-date\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Mobile Number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"03XXXXXXXXX\" value=\"\" type=\"tel\" name=\"phone\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Email<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" placeholder=\"example@email.com\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Country<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"country\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Country name\" value=\"\" type=\"text\" name=\"country\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>City<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"City name\" value=\"\" type=\"text\" name=\"city\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">Full Address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter your complete street, neighborhood, village, or city address\" name=\"address\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">Occupation \/ General Activity<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter your occupation or general activity\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section\">\n\t\t<h3>General Health\n\t\t<\/h3>\n\t\t<p><label class=\"cf7-question\">What is your body type?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"body-type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"body-type\" value=\"Slim\" \/><span class=\"wpcf7-list-item-label\">Slim<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"body-type\" value=\"Average\" \/><span class=\"wpcf7-list-item-label\">Average<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"body-type\" value=\"Overweight\" \/><span class=\"wpcf7-list-item-label\">Overweight<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Height<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"height\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"height\" value=\"Short\" \/><span class=\"wpcf7-list-item-label\">Short<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"height\" value=\"Average\" \/><span class=\"wpcf7-list-item-label\">Average<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"height\" value=\"Tall\" \/><span class=\"wpcf7-list-item-label\">Tall<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Is your work mainly physical or mental?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"work-type\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"work-type\" value=\"Physical\" \/><span class=\"wpcf7-list-item-label\">Physical<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"work-type\" value=\"Mental\" \/><span class=\"wpcf7-list-item-label\">Mental<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you regularly experience any of the following conditions?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"common-issues\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"Cold \/ Flu\" \/><span class=\"wpcf7-list-item-label\">Cold \/ Flu<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"Cough\" \/><span class=\"wpcf7-list-item-label\">Cough<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"Headache\" \/><span class=\"wpcf7-list-item-label\">Headache<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"Weakness \/ Fatigue\" \/><span class=\"wpcf7-list-item-label\">Weakness \/ Fatigue<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"Diabetes\" \/><span class=\"wpcf7-list-item-label\">Diabetes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"High Cholesterol \/ Triglycerides\" \/><span class=\"wpcf7-list-item-label\">High Cholesterol \/ Triglycerides<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"High Uric Acid\" \/><span class=\"wpcf7-list-item-label\">High Uric Acid<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"common-issues[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label>How is your memory?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"memory\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"memory\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Good\">Good<\/option><option value=\"Fair\">Fair<\/option><option value=\"Poor\">Poor<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>How is your eyesight?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"eyesight\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"eyesight\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Good\">Good<\/option><option value=\"Fair\">Fair<\/option><option value=\"Poor\">Poor<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>How is your sleep?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sleep-quality\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"sleep-quality\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Peaceful\">Peaceful<\/option><option value=\"Restless\">Restless<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Blood Pressure<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"blood-pressure\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"blood-pressure\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"High\">High<\/option><option value=\"Normal\">Normal<\/option><option value=\"Low\">Low<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">If you are producing phlegm, please provide details<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phlegm-detail\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter details\" name=\"phlegm-detail\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section\">\n\t\t<h3>Sleep, Temperament and Habits\n\t\t<\/h3>\n\t\t<p><label class=\"cf7-question\">Have you ever fainted?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fainting\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"fainting\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"fainting\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">How many hours do you usually rest?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"rest-hours\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"rest-hours\" value=\"4\u20136 hours\" \/><span class=\"wpcf7-list-item-label\">4\u20136 hours<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"rest-hours\" value=\"6\u20138 hours\" \/><span class=\"wpcf7-list-item-label\">6\u20138 hours<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"rest-hours\" value=\"8\u201310 hours\" \/><span class=\"wpcf7-list-item-label\">8\u201310 hours<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Are you currently experiencing any unusual stress or worry?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"stress\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"stress\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"stress\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"stress\" value=\"Somewhat\" \/><span class=\"wpcf7-list-item-label\">Somewhat<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Which of the following do you regularly use?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"habits\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"habits[]\" value=\"Tea\" \/><span class=\"wpcf7-list-item-label\">Tea<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"habits[]\" value=\"Coffee\" \/><span class=\"wpcf7-list-item-label\">Coffee<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"habits[]\" value=\"Cigarettes\" \/><span class=\"wpcf7-list-item-label\">Cigarettes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"habits[]\" value=\"Naswar \/ Smokeless Tobacco\" \/><span class=\"wpcf7-list-item-label\">Naswar \/ Smokeless Tobacco<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"habits[]\" value=\"All\" \/><span class=\"wpcf7-list-item-label\">All<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"habits[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label>What is your natural temperament?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"temperament\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"temperament\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Cold\">Cold<\/option><option value=\"Hot\">Hot<\/option><option value=\"Phlegmatic\">Phlegmatic<\/option><option value=\"Bilious\">Bilious<\/option><option value=\"Not Sure\">Not Sure<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Which type of foods affects you adversely?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"food-effect\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"food-effect\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Hot\">Hot<\/option><option value=\"Cold\">Cold<\/option><option value=\"Not Sure\">Not Sure<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section\">\n\t\t<h3>Heart, Breathing and Digestion\n\t\t<\/h3>\n\t\t<p><label class=\"cf7-question\">Does your heartbeat increase with more than usual exertion?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"heartbeat\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"heartbeat\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"heartbeat\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you become short of breath while walking or climbing stairs?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"breathing\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"breathing\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"breathing\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you usually experience sour or foul-smelling belching?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"burping\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"burping\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"burping\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you have a good appetite?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"appetite\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"appetite\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"appetite\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you experience heartburn or acidity?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"acidity\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"acidity\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"acidity\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"acidity\" value=\"Sometimes\" \/><span class=\"wpcf7-list-item-label\">Sometimes<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you frequently eat rich, oily foods or fast food?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fast-food\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"fast-food\" value=\"Yes, Often\" \/><span class=\"wpcf7-list-item-label\">Yes, Often<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"fast-food\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"fast-food\" value=\"Sometimes\" \/><span class=\"wpcf7-list-item-label\">Sometimes<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label>How many meals do you eat per day?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"meals\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"meals\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Once\">Once<\/option><option value=\"Twice\">Twice<\/option><option value=\"Three Times\">Three Times<\/option><option value=\"Four Times\">Four Times<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label>Do you commonly experience constipation?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"constipation\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"constipation\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><option value=\"Sometimes\">Sometimes<\/option><\/select><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">How many bowel movements do you have per day, and at what times?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"stool-time\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter details\" name=\"stool-time\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">What is the usual color and consistency of your stool? Is it loose or hard?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"stool-detail\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter details\" name=\"stool-detail\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section\">\n\t\t<h3>Urination, Surgery and Family Medical History\n\t\t<\/h3>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label class=\"full\">How many times do you urinate during the day and night?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"urine-frequency\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter details\" value=\"\" type=\"text\" name=\"urine-frequency\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">What is the usual amount of urine?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"urine-amount\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter details\" value=\"\" type=\"text\" name=\"urine-amount\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><label class=\"cf7-question\">Select any relevant past or family medical issue<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"family-history\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Urinary Problem\" \/><span class=\"wpcf7-list-item-label\">Urinary Problem<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Surgery\" \/><span class=\"wpcf7-list-item-label\">Surgery<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"Family Medical Condition\" \/><span class=\"wpcf7-list-item-label\">Family Medical Condition<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"family-history[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label class=\"full\">If applicable, describe what happened, when it occurred, and who was affected<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"hereditary-disease\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter details\" name=\"hereditary-disease\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section married-section\">\n\t\t<h3>For Married Men\n\t\t<\/h3>\n\t\t<p><label class=\"cf7-question\">Are you satisfied with your marriage?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marriage-satisfied\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"marriage-satisfied\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"marriage-satisfied\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"marriage-satisfied\" value=\"Somewhat\" \/><span class=\"wpcf7-list-item-label\">Somewhat<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label>How long have you been married?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marriage-duration\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter duration\" value=\"\" type=\"text\" name=\"marriage-duration\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">How many children do you have, and what are their ages?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"children-detail\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Enter the number and ages of your children\" name=\"children-detail\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section male-section\">\n\t\t<h3>Male Sexual Weakness \/ Men's Health Issues\n\t\t<\/h3>\n\t\t<p><label class=\"cf7-question\">Do you have any of the following penile concerns?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"male-organ-issues\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"male-organ-issues[]\" value=\"Curvature\" \/><span class=\"wpcf7-list-item-label\">Curvature<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"male-organ-issues[]\" value=\"Small Size\" \/><span class=\"wpcf7-list-item-label\">Small Size<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"male-organ-issues[]\" value=\"Weakness\" \/><span class=\"wpcf7-list-item-label\">Weakness<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"male-organ-issues[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">How would you rate your sexual strength?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"strength-quality\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"strength-quality\" value=\"Very Good\" \/><span class=\"wpcf7-list-item-label\">Very Good<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"strength-quality\" value=\"Good\" \/><span class=\"wpcf7-list-item-label\">Good<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"strength-quality\" value=\"Fair\" \/><span class=\"wpcf7-list-item-label\">Fair<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"strength-quality\" value=\"Poor\" \/><span class=\"wpcf7-list-item-label\">Poor<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"strength-quality\" value=\"None at All\" \/><span class=\"wpcf7-list-item-label\">None at All<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Does the penis shrink in cold water?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"shrink-cold-water\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"shrink-cold-water\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"shrink-cold-water\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">What is the consistency of your semen?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"semen-quality\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"semen-quality\" value=\"Thick\" \/><span class=\"wpcf7-list-item-label\">Thick<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"semen-quality\" value=\"Thin\" \/><span class=\"wpcf7-list-item-label\">Thin<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you experience any of the following?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"male-complaints\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"male-complaints[]\" value=\"Nocturnal Emissions \/ Wet Dreams\" \/><span class=\"wpcf7-list-item-label\">Nocturnal Emissions \/ Wet Dreams<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"male-complaints[]\" value=\"Low Libido\" \/><span class=\"wpcf7-list-item-label\">Low Libido<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"male-complaints[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you experience pain in the penis or muscles?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"organ-muscle-pain\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"organ-muscle-pain\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"organ-muscle-pain\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"organ-muscle-pain\" value=\"Sometimes\" \/><span class=\"wpcf7-list-item-label\">Sometimes<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you experience back pain?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"back-pain\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"back-pain\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"back-pain\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"back-pain\" value=\"Sometimes\" \/><span class=\"wpcf7-list-item-label\">Sometimes<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you experience premature ejaculation?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"premature-ejaculation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"premature-ejaculation\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"premature-ejaculation\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"premature-ejaculation\" value=\"Sometimes\" \/><span class=\"wpcf7-list-item-label\">Sometimes<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label class=\"full\">How frequently do you experience nocturnal emissions?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"wet-dream-frequency\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter details\" value=\"\" type=\"text\" name=\"wet-dream-frequency\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><label class=\"cf7-question\">Do you notice drops after urination?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"urine-drops\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"urine-drops[]\" value=\"Semen\" \/><span class=\"wpcf7-list-item-label\">Semen<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"urine-drops[]\" value=\"Pre-ejaculate\" \/><span class=\"wpcf7-list-item-label\">Pre-ejaculate<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"urine-drops[]\" value=\"Urine\" \/><span class=\"wpcf7-list-item-label\">Urine<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"urine-drops[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you experience any discharge after urination?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"urine-discharge\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"urine-discharge\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"urine-discharge\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Have you experienced persistent nocturnal emissions?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"continuous-wet-dream\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"continuous-wet-dream\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"continuous-wet-dream\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Have you ever masturbated?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"masturbation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"masturbation\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"masturbation\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you have syphilis?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"syphilis\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"syphilis\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"syphilis\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p><label class=\"cf7-question\">Do you have gonorrhea?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gonorrhea\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"gonorrhea\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"gonorrhea\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label class=\"full\">Describe your men's health condition or symptoms in detail<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"male-disease-detail\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Describe your symptoms and concerns in detail\" name=\"male-disease-detail\"><\/textarea><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"cf7-section\">\n\t\t<h3>Important Note for the Patient\n\t\t<\/h3>\n\t\t<div class=\"cf7-grid\">\n\t\t\t<p><label class=\"full\">What is your estimated budget for one month of medication?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medicine-budget\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Enter amount\" value=\"\" type=\"text\" name=\"medicine-budget\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t\t<p><label class=\"full\">Upload any relevant medical reports<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medical-reports\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.jpg,.jpeg,.png\" aria-invalid=\"false\" type=\"file\" name=\"medical-reports\" \/><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"cf7-agreement-box\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"agreement\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"agreement\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I confirm and declare that I have completed this form carefully, thoughtfully, and to the best of my knowledge.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner men-form-submit\" type=\"submit\" value=\"Submit Form\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<style>.men-health-cf7 {\n direction: ltr;\n text-align: left;\n max-width: 1050px;\n margin: 0 auto;\n padding: 35px 16px;\n font-family: Arial, Helvetica, sans-serif;\n color: #263018;\n}\n\n.men-health-cf7 * {\n box-sizing: border-box;\n}\n\n.men-health-cf7 .cf7-form-hero {\n background: linear-gradient(135deg, #294d14, #4e6920);\n color: #ffffff;\n padding: 42px 34px;\n border-radius: 28px;\n margin-bottom: 26px;\n position: relative;\n overflow: hidden;\n box-shadow: 0 18px 45px rgba(41, 77, 20, 0.24);\n}\n\n.men-health-cf7 .cf7-form-hero::after {\n content: \"\";\n position: absolute;\n width: 220px;\n height: 220px;\n left: -70px;\n top: -80px;\n background: rgba(248, 208, 3, 0.18);\n border-radius: 50%;\n}\n\n.men-health-cf7 .cf7-badge {\n display: inline-block;\n background: #f8d003;\n color: #294d14;\n padding: 8px 18px;\n border-radius: 999px;\n font-size: 15px;\n font-weight: 800;\n margin-bottom: 14px;\n}\n\n.men-health-cf7 .cf7-form-hero h2 {\n margin: 0 0 12px;\n color: #ffffff;\n font-size: 36px;\n line-height: 1.6;\n font-weight: 900;\n}\n\n.men-health-cf7 .cf7-form-hero p {\n margin: 0;\n max-width: 780px;\n color: rgba(255,255,255,0.92);\n font-size: 17px;\n line-height: 2;\n}\n\n.men-health-cf7 .cf7-section {\n background: #ffffff;\n border: 1px solid rgba(78, 105, 32, 0.18);\n border-radius: 24px;\n padding: 28px;\n margin-bottom: 22px;\n box-shadow: 0 12px 35px rgba(41, 77, 20, 0.08);\n}\n\n.men-health-cf7 .cf7-section h3 {\n margin: 0 0 22px;\n padding-bottom: 15px;\n color: #294d14;\n font-size: 26px;\n line-height: 1.7;\n font-weight: 900;\n border-bottom: 2px solid rgba(217, 170, 49, 0.32);\n position: relative;\n}\n\n.men-health-cf7 .cf7-section h3::after {\n content: \"\";\n position: absolute;\n left: 0;\n bottom: -2px;\n width: 110px;\n height: 2px;\n background: #84c225;\n}\n\n.men-health-cf7 .male-section,\n.men-health-cf7 .married-section {\n background: linear-gradient(180deg, #fffdf2, #ffffff);\n border-color: rgba(248, 208, 3, 0.38);\n}\n\n.men-health-cf7 .cf7-grid {\n display: grid;\n grid-template-columns: repeat(2, 1fr);\n gap: 18px;\n}\n\n.men-health-cf7 label {\n display: block;\n color: #263018;\n font-size: 16px;\n font-weight: 800;\n line-height: 1.9;\n}\n\n.men-health-cf7 label.full {\n grid-column: 1 \/ -1;\n}\n\n.men-health-cf7 input[type=\"text\"],\n.men-health-cf7 input[type=\"email\"],\n.men-health-cf7 input[type=\"tel\"],\n.men-health-cf7 input[type=\"number\"],\n.men-health-cf7 input[type=\"date\"],\n.men-health-cf7 select,\n.men-health-cf7 textarea {\n width: 100%;\n margin-top: 7px;\n border: 1px solid rgba(78, 105, 32, 0.22);\n background: #fbfff6;\n border-radius: 15px;\n padding: 13px 15px;\n color: #263018;\n font-size: 15px;\n line-height: 1.8;\n font-family: inherit;\n outline: none;\n transition: 0.25s ease;\n}\n\n.men-health-cf7 textarea {\n min-height: 115px;\n resize: vertical;\n}\n\n.men-health-cf7 input:focus,\n.men-health-cf7 select:focus,\n.men-health-cf7 textarea:focus {\n border-color: #84c225;\n background: #ffffff;\n box-shadow: 0 0 0 4px rgba(132, 194, 37, 0.16);\n}\n\n.men-health-cf7 .cf7-question {\n margin: 18px 0 10px;\n padding: 15px 18px;\n background: #f7fbef;\n border-left: 5px solid #84c225;\n border-radius: 16px;\n color: #294d14;\n font-size: 17px;\n font-weight: 900;\n}\n\n.men-health-cf7 .wpcf7-radio,\n.men-health-cf7 .wpcf7-checkbox {\n display: flex;\n flex-wrap: wrap;\n gap: 12px;\n margin: 10px 0 16px;\n}\n\n.men-health-cf7 .wpcf7-list-item {\n margin: 0 !important;\n}\n\n.men-health-cf7 .wpcf7-list-item label {\n display: inline-flex;\n align-items: center;\n gap: 8px;\n background: #ffffff;\n border: 1px solid rgba(78, 105, 32, 0.22);\n border-radius: 999px;\n padding: 10px 16px;\n font-size: 15px;\n font-weight: 700;\n line-height: 1.5;\n cursor: pointer;\n transition: 0.2s ease;\n}\n\n.men-health-cf7 .wpcf7-list-item label:hover {\n border-color: #84c225;\n background: #f7fbef;\n}\n\n.men-health-cf7 input[type=\"radio\"],\n.men-health-cf7 input[type=\"checkbox\"] {\n accent-color: #4e6920;\n width: 16px;\n height: 16px;\n}\n\n.men-health-cf7 input[type=\"file\"] {\n width: 100%;\n margin-top: 8px;\n padding: 14px;\n background: #fbfff6;\n border: 1px dashed #84c225;\n border-radius: 15px;\n color: #294d14;\n font-family: inherit;\n}\n\n.men-health-cf7 .cf7-agreement-box {\n background: #f7fbef;\n border: 1px solid rgba(132, 194, 37, 0.35);\n border-radius: 18px;\n padding: 16px 18px;\n margin: 22px 0;\n}\n\n.men-health-cf7 .wpcf7-acceptance label {\n display: flex;\n align-items: flex-start;\n gap: 10px;\n font-size: 16px;\n line-height: 2;\n}\n\n.men-health-cf7 .men-form-submit {\n width: 100%;\n border: none;\n background: linear-gradient(135deg, #4e6920, #294d14);\n color: #ffffff;\n border-radius: 18px;\n padding: 17px 24px;\n font-size: 20px;\n font-weight: 900;\n line-height: 1.7;\n font-family: inherit;\n cursor: pointer;\n box-shadow: 0 14px 30px rgba(41, 77, 20, 0.25);\n transition: 0.25s ease;\n}\n\n.men-health-cf7 .men-form-submit:hover {\n background: linear-gradient(135deg, #294d14, #4e6920);\n transform: translateY(-2px);\n box-shadow: 0 18px 38px rgba(41, 77, 20, 0.32);\n}\n\n.men-health-cf7 .wpcf7-not-valid-tip {\n color: #b91c1c;\n font-size: 13px;\n margin-top: 6px;\n}\n\n.men-health-cf7 .wpcf7-response-output {\n border-radius: 14px;\n padding: 14px 18px !important;\n margin: 20px 0 0 !important;\n font-size: 15px;\n line-height: 1.8;\n}\n\n@media (max-width: 768px) {\n .men-health-cf7 {\n padding: 24px 12px;\n }\n\n .men-health-cf7 .cf7-form-hero {\n padding: 30px 22px;\n border-radius: 22px;\n }\n\n .men-health-cf7 .cf7-form-hero h2 {\n font-size: 28px;\n }\n\n .men-health-cf7 .cf7-section {\n padding: 22px 16px;\n border-radius: 20px;\n }\n\n .men-health-cf7 .cf7-section h3 {\n font-size: 22px;\n }\n\n .men-health-cf7 .cf7-grid {\n grid-template-columns: 1fr;\n }\n\n .men-health-cf7 .wpcf7-radio,\n .men-health-cf7 .wpcf7-checkbox {\n flex-direction: column;\n }\n\n .men-health-cf7 .wpcf7-list-item label {\n width: 100%;\n border-radius: 14px;\n }\n}\n<\/style><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-16088","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.4 (Yoast SEO v26.4) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Diagnostic form for men - Sulemani<\/title>\n<meta name=\"description\" content=\"- Sulemani\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sulemani.com.pk\/en\/diseases-of-men\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diagnostic form for men - Sulemani\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sulemani.com.pk\/en\/diseases-of-men\/\" \/>\n<meta property=\"og:site_name\" content=\"Sulemani\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/idarasulemani\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-03T03:24:01+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/sulemani.com.pk\/wp-content\/uploads\/2021\/11\/sulemani-matab.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1170\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/\",\"url\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/\",\"name\":\"Diagnostic form for men - Sulemani\",\"isPartOf\":{\"@id\":\"https:\/\/sulemani.com.pk\/#website\"},\"datePublished\":\"2021-10-23T07:13:48+00:00\",\"dateModified\":\"2026-08-03T03:24:01+00:00\",\"description\":\"- Sulemani\",\"breadcrumb\":{\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/sulemani.com.pk\/diseases-of-men\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/sulemani.com.pk\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Diagnostic form for men\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/sulemani.com.pk\/#website\",\"url\":\"https:\/\/sulemani.com.pk\/\",\"name\":\"Sulemani\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/sulemani.com.pk\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/sulemani.com.pk\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Organization\",\"Place\",\"HealthAndBeautyBusiness\"],\"@id\":\"https:\/\/sulemani.com.pk\/#organization\",\"name\":\"Matab Sulemani\",\"url\":\"https:\/\/sulemani.com.pk\/\",\"logo\":{\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-organization-logo\"},\"image\":{\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-organization-logo\"},\"sameAs\":[\"https:\/\/www.facebook.com\/idarasulemani\"],\"description\":\"Sulemani Publications is a heritage institution dedicated to preserving and promoting Unani medicine through authentic, affordable and research-based books. Founded in 1968 by Hakim Abdul Waheed Sulemani, the organization has published over 300 titles covering classical remedies, formulations, clinical treatments, pharmacology, Ayurvedic methods and academic syllabi. With decades of service, the institute remains committed to advancing traditional medicine, supporting researchers and authors, and making quality medical knowledge accessible to students, practitioners and readers worldwide.\",\"legalName\":\"Sulemani\",\"foundingDate\":\"1968-01-21\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"11\",\"maxValue\":\"50\"},\"ownershipFundingInfo\":\"https:\/\/sulemani.com.pk\/about\/\",\"address\":{\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-place-address\"},\"telephone\":[\"0312-736-1408\",\"042-3736-1408\"],\"openingHoursSpecification\":[{\"@type\":\"OpeningHoursSpecification\",\"dayOfWeek\":[\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\",\"Sunday\"],\"opens\":\"09:00\",\"closes\":\"17:00\"}],\"email\":\"sulemani@gmail.com\"},{\"@type\":\"PostalAddress\",\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-place-address\",\"streetAddress\":\"Matab Hakeem Abdul Waheed Sulemani, 3B Niaz View Backside Khan Baba Hotel Choburji, Rewaz Gardens, Lahore, Punjab 54000, Pakistan, Punjab 54000, Pakistan\",\"addressLocality\":\"Lahore\",\"postalCode\":\"54000\",\"addressRegion\":\"Punjab\",\"addressCountry\":\"PK\"},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-organization-logo\",\"url\":\"https:\/\/sulemani.com.pk\/wp-content\/uploads\/2017\/04\/sulemani-logo-final.png\",\"contentUrl\":\"https:\/\/sulemani.com.pk\/wp-content\/uploads\/2017\/04\/sulemani-logo-final.png\",\"width\":118,\"height\":118,\"caption\":\"Matab Sulemani\"}]}<\/script>\n<meta name=\"geo.placename\" content=\"Lahore\" \/>\n<meta name=\"geo.region\" content=\"Pakistan\" \/>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Diagnostic form for men - Sulemani","description":"- Sulemani","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/sulemani.com.pk\/en\/diseases-of-men\/","og_locale":"en_US","og_type":"article","og_title":"Diagnostic form for men - Sulemani","og_url":"https:\/\/sulemani.com.pk\/en\/diseases-of-men\/","og_site_name":"Sulemani","article_publisher":"https:\/\/www.facebook.com\/idarasulemani","article_modified_time":"2026-08-03T03:24:01+00:00","og_image":[{"width":1170,"height":600,"url":"https:\/\/sulemani.com.pk\/wp-content\/uploads\/2021\/11\/sulemani-matab.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/","url":"https:\/\/sulemani.com.pk\/diseases-of-men\/","name":"Diagnostic form for men - Sulemani","isPartOf":{"@id":"https:\/\/sulemani.com.pk\/#website"},"datePublished":"2021-10-23T07:13:48+00:00","dateModified":"2026-08-03T03:24:01+00:00","description":"- Sulemani","breadcrumb":{"@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/sulemani.com.pk\/diseases-of-men\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/sulemani.com.pk\/"},{"@type":"ListItem","position":2,"name":"Diagnostic form for men"}]},{"@type":"WebSite","@id":"https:\/\/sulemani.com.pk\/#website","url":"https:\/\/sulemani.com.pk\/","name":"Sulemani","description":"","publisher":{"@id":"https:\/\/sulemani.com.pk\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/sulemani.com.pk\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Organization","Place","HealthAndBeautyBusiness"],"@id":"https:\/\/sulemani.com.pk\/#organization","name":"Matab Sulemani","url":"https:\/\/sulemani.com.pk\/","logo":{"@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-organization-logo"},"image":{"@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-organization-logo"},"sameAs":["https:\/\/www.facebook.com\/idarasulemani"],"description":"Sulemani Publications is a heritage institution dedicated to preserving and promoting Unani medicine through authentic, affordable and research-based books. Founded in 1968 by Hakim Abdul Waheed Sulemani, the organization has published over 300 titles covering classical remedies, formulations, clinical treatments, pharmacology, Ayurvedic methods and academic syllabi. With decades of service, the institute remains committed to advancing traditional medicine, supporting researchers and authors, and making quality medical knowledge accessible to students, practitioners and readers worldwide.","legalName":"Sulemani","foundingDate":"1968-01-21","numberOfEmployees":{"@type":"QuantitativeValue","minValue":"11","maxValue":"50"},"ownershipFundingInfo":"https:\/\/sulemani.com.pk\/about\/","address":{"@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-place-address"},"telephone":["0312-736-1408","042-3736-1408"],"openingHoursSpecification":[{"@type":"OpeningHoursSpecification","dayOfWeek":["Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"],"opens":"09:00","closes":"17:00"}],"email":"sulemani@gmail.com"},{"@type":"PostalAddress","@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-place-address","streetAddress":"Matab Hakeem Abdul Waheed Sulemani, 3B Niaz View Backside Khan Baba Hotel Choburji, Rewaz Gardens, Lahore, Punjab 54000, Pakistan, Punjab 54000, Pakistan","addressLocality":"Lahore","postalCode":"54000","addressRegion":"Punjab","addressCountry":"PK"},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/sulemani.com.pk\/diseases-of-men\/#local-main-organization-logo","url":"https:\/\/sulemani.com.pk\/wp-content\/uploads\/2017\/04\/sulemani-logo-final.png","contentUrl":"https:\/\/sulemani.com.pk\/wp-content\/uploads\/2017\/04\/sulemani-logo-final.png","width":118,"height":118,"caption":"Matab Sulemani"}]},"geo.placename":"Lahore","geo.region":"Pakistan"},"_links":{"self":[{"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/pages\/16088","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/comments?post=16088"}],"version-history":[{"count":9,"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/pages\/16088\/revisions"}],"predecessor-version":[{"id":21948,"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/pages\/16088\/revisions\/21948"}],"wp:attachment":[{"href":"https:\/\/sulemani.com.pk\/en\/wp-json\/wp\/v2\/media?parent=16088"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}