HOMOEOPATHY PRODUCTS
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.
 
 
   

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