WELCOME TO SHREEJI HOMEO CLINIC

HOMOEOPATHY PRODUCTS

Shreeji Injury care Kit

Shreeji animal Kit

Shreeji Travel care Kit

Shreeji 12 Bio-Chemic Kit

Shreeji Emergency care Kit

Shreeji Respiratory care Kit

Shreeji Child care Kit

Shreeji Sports Kit

Shreeji Top Remedies Kit

VETERINARY PRODUCTS

Patient Details
	Patient Details Are Compulsory
Name:
Age:
Sex:
Marital Status:
Occupation:
Address:
City:
Country:
Phone:
Email:

Chief Complains

Chief Complaints:

If the case is already diagnosed then diagnosis of the case

If investigations done, reports of investigations

Under any medication, if yes specify:

Present History

Whether patient is suffering from any diseases like Arthritis, Blood Pressure, Diabetes, HIV, Tuberculosis Or cancer specify since when:

Past History

Any diseases which occurred in the past Tuberculosis, Hepatitis, Typhoid etc. any others specify when:

If Patient has undergone any surgical intervention for what and when:

Family History

Family history of any diseases (for Father, Mother, Brother, Sister) Blood pressure, Diabetes Mellitus, Hepatitis, Tuberculosis, Cancer, HIV Infection etc. any others specify Arthritis:

If married – about children. Any diseases specify:

Patient Nature

Appetite:

Thirst:

Craving for any food items specify:

Aversion for any food items:

Perspiration:

Any parts specify:

Offensive smell:

Urine:

Pain:

If yes type of pain specify:

Motion:

No. of times /days:

Thermal:

Climate – which patient prefers:

Addictions :

Tobacco:Lif yes quantity :

Alcohol:Lif yes quantity :

Drugs:Lif yes quantity :

Takes bath in:

For Females: Menstrual history

First Menstrual Period:

Last Menstrual Period:

Attained Menopause:

Aversion for any food items:

Perspiration:

Complaint associated with Menses:

Before:

During:

After:

Leucorrhoea:

Sexual History

About sexual life. Any problems specify:

About fertility. if any problems:

Mental Features of the patient

Patients reaction towards the society. Whether irritable, anxious, tension, attachments, likes company of friends, brooding, any suicidal thoughts.

Any other symptoms Specify:

We need an elaborate case history for selection of remedy. Please co-operate with us and fill necessary columns.