If you want tele-consultation, please fill in the basic information and send it to us. We will contact you for necessary guidance.

Primary information

1. Name …………………………………………………………………………………..  
2. Age / Gender …………………………………..     
3. Address : City / State ………………………………………………… …………………………………………………………. …    
4. Mobile Number ……………………………………………………………………………………..    
5. Email Address ……………………………………………………………………………………   
6. Date of Spinal cord injury / disease ……………………………. …………         
7. Level of spinal cord injury ………………………………. ………………….       
8. Hand function :  Yes / OK …………  Not adequate for CIC ……………                             
9. Current method of bladder management : …………………………………………………………………………

?       Indwelling Urethral Foley Catheter ………………………………………..  

?       Suprapubic catheter …………………………………………………………………………    

• CIC ( Intermittent Cath ) / Clean Intermittent Catheterization ……………………. ……    
• self urinating ………………………………………………………. …………..   
• Only urine collection – ( diapers or condom- external cath)…………………………  

 10. Are you taking any bladder medicines? …………………… 

11. Share any test report done for urinary problem? …………………………………….  

Please send it to WhatsApp by Mobile 9811039856 or

send email to at contact@scibladder.com