Consultation


Preliminary data :

  1. (required)
  2. (valid email required)
  6. Marital status

  8. Siblings



Planning an effective treatment

  1. Diet

  3. Appetite/hunger


  5. Digestion



  7. Food intake




  10. Pattern of eating

  12. Thirst


  14. preference to



Motion: frequency - how many times a day?

  1. consistency



  3. urgency

  5. satisfaction

  7. first stool


  9. any discomfort or pain


  11. bleeding




Urine : frequency: how many times a day

  1. night

  3. urgency

  5. flow


  7. control


  9. difficulty/pain



Sleep : duration

  1. character of sleep


  3. quality of sleep

  5. sleep disturbance

  7. sleep disturbance


  9. afternoon sleep

  11. covering during sleep




  13. dreams

  15. dreams

  17. dreams


  19. Sexual function




Menstrual function

  1. cycles



  4. flow


  6. clots

  8. pain during periods


  10. any complaints


  12. white discharge




Perspiration / sweating pattern

  1. part

  3. odor (smell)



Obstetric history



Developmental history ( for children)

  1. mode of birth


  12. general nature


  16. Physical appearance


  18. Skin

  20. 18. Nails: any problem


  22. Hair on head




Mind / emotions



  5. impulsive



  11. easy depression

  13. anxiety prone



  19. cosmopolitan


  23. Any habits