Why every programme starts with a diagnosis and a written fee

Key takeaways

• Every programme follows the same four steps: diagnosis first, fees in writing before you pay, review dates fixed on day one, and a plan for the end.
• A diagnosis decides which option, if any, suits you. The same symptom can need very different treatment.
• Indian medical ethics has long asked doctors to state fees before treatment, not after it is under way.
• We do not run discounts, festival offers or time-limited deals. The written fee is the fee.
• We order only the tests you need. In midlife care, tests are charged at actual cost.

What are the four steps every programme follows?

Whether you come to us for hair, weight or midlife health, the structure is the same:

1. Diagnosis first. A doctor works out what is actually going on.
2. Fees in writing before you pay. You see the cost of each option you are offered.
3. Review dates fixed on day one. Follow-up is scheduled at the start, not left open.
4. A plan for the end. You know what maintenance looks like before you begin.

These four steps came out of how I have worked since I opened the clinic in Thane in 2005. Here I explain the first two in detail, because they are the ones people ask me about most.

Why does diagnosis come before any package?

Because the same complaint can have very different causes, and the cause decides the treatment.

Take hair. Two people can walk in saying "my hair is thinning". For one, the hair was always fine and sparse. For the other, the hair fell after an illness two years ago. What I tell people is this: "If you're born with hair which is thin, it cannot change. If you have lost hair in the last three, four years, that can come back." Selling both people the same package would be dishonest to at least one of them.

The same is true in midlife care. My colleague Dr Anagha Karkhanis treats by symptoms rather than a single blood test, because hormones swing through the day in perimenopause. This matches guidance from NICE in the UK, which says women over 45 with typical symptoms can be diagnosed with perimenopause or menopause on symptoms alone, without confirmatory hormone tests. So her diagnosis is a long conversation through every symptom, not a 70 or 80 test package.

And in weight care, the Rs 499 eligibility consult exists because not everyone should be on a GLP-1 medicine. Whether semaglutide or tirzepatide is suitable is a prescription decision I make after assessment.

What does each first step cost?

These are the fees for starting each programme. The fee for any further option is given to you in writing once the diagnosis is done.

For hair transplants, there is no fixed price on the website because the right plan depends on the diagnosis. If a transplant is appropriate, it is quoted in writing after the diagnosis, with a named qualified surgeon.

Why put the fee in writing?

I have three practical reasons.

You can compare and decide calmly. A written fee can be taken home, discussed with family and thought over. Many decisions about appearance or health are made jointly in Indian households, and a number on paper makes that conversation easier.

There are no surprises halfway. India's Code of Medical Ethics Regulations, 2002 says a physician should announce fees before rendering service, and not after the operation or treatment is under way. I treat that as a basic rule, not a courtesy.

It removes pressure. When the price is fixed and written down, there is nothing to negotiate in the moment and no reason to rush.

Why don't you offer discounts or festival deals?

Because a discount is a reason to start treatment that has nothing to do with whether you need it.

The National Medical Commission's Guidelines on Ethical Advertising and Public Communication, issued on 6 October 2026, allow doctors and clinics to state charges factually, but not to use them as an inducement. Offers, discounts and time-limited deals that might push people towards unnecessary consultations, tests or treatment are not allowed. I agree with the spirit of that rule. Honestly, anything too commercial has never sat well with me. You will not see a "Diwali offer" from us. The fee you are quoted in writing is the fee.

I explain how these rules shape our website in why you won't see before-and-after photos on our website.

What about tests?

My principle is: only the tests you need.

• In midlife care, the general bloods come first. DEXA bone density, sonography or a Pap smear are added only where indicated. Tests are charged at actual cost.
• In hair and weight care, if I suggest a test, it is fair to ask me what question it answers and how the result would change the plan.

Basically, a test should answer a question. If its result would not change what I recommend, it is usually not worth your money.

What happens after the diagnosis?

You leave with a clear picture:

• What I think is happening.
• The options, including doing nothing or waiting.
• The written fee for each option.
• If you go ahead, your review dates, and the maintenance plan.

I offer options and you choose. I do not push. That is very important to understand, because the diagnosis is not a sales meeting. It is the part of the visit that protects you most.

For a step-by-step picture of the day, see what happens at your first consultation.

How we approach this at Dr Tvacha

Start with the diagnosis that fits your concern: an online weight eligibility consult, a hair diagnosis at any of our four centres, or the Midlife Women's Health Check under women's health at Cocoon × Dr Tvacha in Thane. You will have the fees in writing before you pay for anything further, and the choice stays yours.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.