Paid Consultation Form Please enable JavaScript in your browser to complete this form.Consultation Choice *--- Select Choice ---Online Homoeopathic ConsultationIn-Clinic Homoeopathic ConsultationDiet ChartName *Email *Your Phone Number *Your general nature : (Anger, extrovert or introvert, emotional, decision making quality, childhood nature, how you take criticism etc.)Details about your present Disease/ailments in order of appearance with durationIf you have already seen a doctor, what diagnosis did they give you?What investigations, tests have you undergone? Please mention the reports and brief treatment history.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.Past History : (Diseases or symptoms you have suffered in past, with treatment history)Physical GeneralsWhich weather you prefer most :Appetite :Thirst :Liking for specific taste/food :Urine :Stool :Perspiration :Sleep pattern, position during sleep :Speed (walking, eating, working) :Sensitivity : (To noise/ light/ sunlight/ high neck, ties/ narrow places/ closed rooms/ traveling in vehicles/ by air/ perfumes/ dust/ others)FemalesGynae and Obs history :Menstrual history :Age of menarche/ menopause :History of abortions or miscarriage :Family historyName the diseases which your father/ mother/ siblings might have sufferedAnything else you would like to share with the doctor?Cigarettes/week :Alcohol units/week :Exercise sessions/week :add on Expectations (Please check this is correct.) We respond within 2 working days. Click on the Submit and Pay button below to send us your form and proceed to Payment Gateway.NameSubmit and Pay
