Online Homeopathic Doctor

• Name*
• Age/ DOB *
• Sex *
  Male Female
• Occupation
• Marital Status
  Single Married
• Height (cm) *
• Weight (kg) *
• Blood Pressure
• Address *
• Mobile No. *
• Email Id *
• Full picture of the patient

(Complaint, cause of the complain, duration of the complaint, problem increases or decreases during for eg pain in leg during morning and gets better by pressing )

• Present Disease
  Picture of the area of the complaint eg any skin disease

[We need to know this because sometimes current problem relates with previous ones] (Any major Illness, Surgery, Accidents, Hospitalization, Vaccunation, Drug Reaction, Animal Bites in the past age which occured)

• Diet
  Regular Irregular
• Food
  Veg Non-Veg

• Relationship at Home and Workplace

• Smoking
  Yes No
• Alcohol
  Yes No
• Tobacco Chewing
  Yes No
• Sleeping Pills
  Yes No
• Laxatives Or Purgatives
  Yes No
• Exercise
  Yes No
• Any Others
• Any Hobbies
• Any Allergies

(Any disease in your grand parents, parents, any siblings or present in family)

(Any disease in your grand parents, parents, any siblings or present in family)

• Menarche 1st Occurance Of Menses
• Menopause Cesation Of Menses
• Menstrual Cycle Duration
• Any complaint before During Or After Menses
• No. Of children
• Any complication in pregnancy
• Mode of delivery
  Normal Cesarean Episiotomy
• Any Abortion
  Miscarraige Still Birth

• Appetite
  Increased Decreased
• No. of times in a day
• Thirst
  Select Cold Hot Icy Cold Drinks
• Desire
  Select Spicy Salty Sweet Sour Bitter Pickles
• Craving
• Dislike (Does not like to eat)
• Disagree (Causes problem after eating)
• Taste
• Perspiration (Odour, Stains the Cloth, Location on the body, Quantity)
• Stool (Character, no. of times/ day)
• Urine (Character, no. of times/ day)
• Sleep (Pattern, Position)
• Dreams (Any recurrent dream)
• Weather you prefer
  Select Winter Summer Rainy Cloudy Winter to summer Summer to winter
• Sensitivity (Light, Noise, Neck ties, Closed rooms, Travelling in vehicles)
• Picture of the tongue

(Your General Nature, Emotions, Understanding, Memory, Fear, lifestyle, Decision making qualtiy, Stress, Extrovert Or Introvert, How do you take critism, Attachment, Any Anxiety)

(Family history and social environment in which you live, No. Of friends, how quickly you mix with new people)

(If done recently) Upload pictures- of your reports