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 SUBMISSION OF MEDICAL CASES BY PATIENTS FOR TREATMENT :
 

You may submit your Medical case to us with full details. Readers visiting this site shall be interested in suggesting probable remedies.

 

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Details required can be listed as:
 
First Name : *
Middle Name :
Last Name : *
Age : *
Sex :
Male
Female		 *

Occupation

 : *

E-mail ID

 : *
Signs & Symptoms : *
Aggravation & Amelioration : *
Causative Factor : *

Concomitant Symptoms

: *

Mental Symptoms

: *
Dreams : *
Habits : *
 

Comments on the following be also be made:-
  • Appetite
 : *
  • Likes & dislikes
 : *
  • Thirst
 : *
  • Urine
 : *
  • Stool
 : *
  • Perspiration
 : *
     

Family history of any illness; present and past.

: *
Self - Past History of any illness; present or past. : *

Reaction to environmental changes.

 : *
     
Females Section:
Menstrual history.    
  • Cycle
 :
  • Duration
 :
  • First Menstrual period
 :
  • Last menstrual period
 :
  • Leucorrhoea
 :
  • Complaints before, during or after menses
 :
  • Quantity
 :
  • Odor
 :
  • Consistency (clots etc.)
 :
 

Obstetrics History.

  • Gravida
 : *
  • Parous
 : *
  • Living
 : *
  • Aborted
 : *
  • H/O Contraception
 : *
     

Childhood history.  
  • Milestones
 : *
  • Teething
 : *
  • Congenital defects
 : *
  • Congenital abnormalities
 : *
  • Vaccination
 : *
  • Bed wetting
 : *
  • Salivation
 : *
  • History of

           - Eruptive fevers

 : *

           - Convulsions

 : *

           - Worms

 : *

           - Urinary tract infection

 : *

           - Respiratory tract infection

 : *
 

Treatment Taken for existing illness

: *
 
* Indicates Mandatory