Services - Ashtanga Ayurvedics

Names*
Email*
Address*
Country*
Postal Code*
Fax No
Contact No*
Age*
Gender*
Marital Status
Weight*
Height*
Structure
- Obese
- Lean
- Medium
Present complaints with full history
Hereditary factor: Has the patient or his/her near relatives had such complaint ? if so, furnish details in brief.
Any cause known to you for the disease
Any history of venereal disease, malaria, filaria or any other noticeable ailments.
State of Appetite, Digestion, Motion, Urine, Sleep.
Dietary habits
Vegetarian or non vegetarian food articles being taken and their timings.
Addiction to smoking, alcohol, etc.
Nature of Work
Number of issues/kids
Menstruation, delivery, etc, problem if any (for women).
Climate & present weather conditions of the place where you live. Any problem of pollution of air, water, etc.
Treatment done so far
Details of Investigation / Medical Reports.
Any Known Allergies
Other information, if any
Blood pressure
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