SUBMIT YOUR VERY BASIC CASE DETAILS (Your basic physical and or mental symptoms goes here)
Please Fill This For Your Basic Information
Email address *
Your Name : *
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Your Country and City. *
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Gender *
Age *
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Occupation (This is often relevant to your health as are unusual hobbies) *
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Any addictions?
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Whats-App Number / Phone Number, and Address *
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Details about your present Disease in order of appearance with duration *
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Your General Nature :(Anger, extrovert or introvert, emotional, decision making quality, suffering from indecision, childhood nature, how you take criticism etc.)
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Past Disease History Since Your Childhood
Are You Suffering From _
Your Dreams While Sleeping
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Any Surgery Done?
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If you have already seen a doctor, what diagnosis did they give you?
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What investigations, tests have you undergone? Please mention the reports and brief treatment history.
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Is there anything else that might be helpful or relevant to your problem? including allergies, illnesses that run in the family and a little bit about your lifestyle.
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Height
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Weight
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Which weather you prefer most ?
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Appetite :
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Thirst :
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Liking for specific taste/food :
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Urine :
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Stool :
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Perspiration :
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Sleep pattern and or position during sleep :
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Sensitivity :(To noise/ light/ sunlight/ high neck, ties/ narrow places/ closed rooms/ traveling in vehicles/ by air/ perfumes/ dust/ others)
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Female Problems
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