Patient Enquiry - Consultation with Nirogam
Please share some more details about your medical history and lifestyle in the form below.
Our ayurvedic doctor will soon be in touch with advice on the best course of treatment for you.
If you have not yet booked a slot, please pay and book here :
Where are you from?
Prefer not to answer
List factors that make your condition worse
List factors that make you feel better
Tell us how many hours sleep you get in a night
> 8 hours of sleep at night
6 - 8 hours of sleep at night
< 6 hours of sleep at night
Tell us about your bowel movements
Regular and Normal stools
Semi solid stools
Have you had any serious illness before? If yes, please give details.
Have you had any minor or major surgeries? If yes, please give details.
Family Medical History
Do your parents or brother/sister have any serious illness? If yes, please give details.
Give information on your current health issues.
Current Medication with Dosage
List medicines with dose and since when you're taking these medicines.
Sedentary (Desk job and no physical activities)
Moderately Active (30 min-1 hour daily walk/gym/games)
Very Active (>1 hr daily walk/gym/games)
Send me a copy of my responses.
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