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Homeopathic Treatment

What is Homeopathy Cancer

Disease Kidney Disease Male

Infertility & Oligospermia

Female Infertility & Pregnancy

Problem

Sexual Problem

	Sexual Ejaculation Problems
	Penis Erection Problems
	Lack of Desire for Sex
	More Masturbation Worries
	Anaxiet About Intercourse
	Excessive Desire for Sex
	Painful Intercourse \| Dyespareunia

Psoriasis Leucoderma

Hair Looses

Skin Disease

Allergic Disease Headache

Migraine

Autism | Dyslexia Stress Management

Autism / Dyslexia

Stress Management

Bone Joint

Gastric Disorder

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Patient Consultation

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Online Homeopathy Consultancy : Patient History

Patient Details

Name*

:

Age*

:

Sex

:

Marital Status

:

Occupation

:

Address

:

City*

:

Country*

:

Phone

:

Email*

:

Chief Complains

Chief Complaints

:

If the case is already diagnosed then diagnosis of the case

:

If investigations done, reports of investigations

:

Under any medication, if yes specify

:

Present History

Whether patient is suffering from any diseases like Arthritis, Blood Pressure, Diabetes, HIV, Tuberculosis Or cancer specify since when

:

Past History

Any diseases which occurred in the past Tuberculosis, Hepatitis, Typhoid etc. any others specify when

:

If Patient has undergone any surgical intervention for what and when

:

Family History

Family history of any diseases (for Father, Mother, Brother, Sister) Blood pressure, Diabetes Mellitus, Hepatitis, Tuberculosis, Cancer, HIV Infection etc. any others specify Arthritis

:

If married – about children. Any diseases specify

:

Patient Nature

Appetite

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Thirst

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Craving for any food items specify

:

Aversion for any food items

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Perspiration

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Any parts specify

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Offensive smell

:

Urine

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Pain

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If yes type of pain specify

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Motion

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No. of times /days

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Thermal :

:

Climate – which patient prefers

:

Takes bath in

:

Addictions

:

Tobaco		if yes quantity
Alcohol		if yes quantity
Drug		Specify

For Females: Menstrual history

First Menstrual Period

:

Last Menstrual Period

:

Attained Menopause

:

Aversion for any food items

:

Perspiration

:

Complaint associated with Menses

:

Before
During
After

Leucorrhoea

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Sexual History

About sexual life. Any problems specify

:

About fertility. if any problems

:

Mental Features of the patient

Patients reaction towards the society. Whether irritable, anxious, tension, attachments, likes company of friends, brooding, any suicidal thoughts.

Any other symptoms Specify

:

We need an elaborate case history for selection of remedy. Please co-operate with us and fill necessary columns.

Email: info@homeopathyonline.in

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