What is the reason of the consultaion ? please mention all the symptoms.
For how long do you have that?
Do you have a diagnosis? if yes, please explain.
Are you receiving any complimentary or alternative modality?(physiotherapy/other types of energy healing/acupuncture/ETC.) if yes, please explain.
Are you taking medications or natural supplements? if yes, please mention.
Do you have any surgical history? if yes, please explain.
Did you have any health problem in the past (heart attack/paralysis/ETC.)? if yes, please mention.
Do you have any problem with the digestive system (indigestion/vomiting/diarrhea/contipation/high cholesterol/ETC.)? if yes, please explain.
Do you have any problem with the respiratory system ( asthma/sinusitis/ETC.)? if yes, please explain.
Do you have any problem with the nervous system(numbness/facial tics/ETC.)? if yes, please explain.
Do you have any problem with the urinary system (urinary infection/kidney stones/ETC.)? if yes, pleaes explain.
Do you have any problem with the reproductive system (myoma/ovarian cyst/ETC.)? if yes, please explain.
Do you have any problem with the muscular system (arthritis/lower back pain/stiff neck/ETC.)? if yes, please explain.
Do you have any problem with the cardiovascular system (irregular heartbeat/hypotension/ETC.)? if yes, please explain.
Do you have any skin problem ( eczema or dermatitis/skin allergy/ETC.)? if yes, please explain.
Do you have any problem with the indocrine system (diabetes/hyperthyroidism/ETC.)? if yes, pleaes explain.
Do you have cancer, or a history of cancer? if yes, please explian.
Do you have any stress/anxiety/depression or any psychiatric condition? if yes, please explian.
How is your energy level?
I declare that the info I’ve provided is accurate & complete
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