Total item( 0 )
Ayurveda 4 All

Consult A Dcotor

» Free Consultation

FREE Online Consultation from leading health care professionals in various specialties. Send in your medical queries and get an opinion. You save your money and time. We guarantee the answer on your question in a 24 hours term. . Alternatively send it to us at
ayuherbal@yahoo.com


Consultation Form
Your Personal Details

*Your Name :

*Your E-Mail :

*Phone :(Include Country/Area Code)

Fax :(Include Country/ Area Code)

Street Address :

*City/State :

*Zip/Postal Code :

*Country :

*Height

 Feet   Inches

*Weight

   Pounds

Occupation

Climate you live in

Your Health Details

*What is the name of your disease as diagnosed by conventional medicine?

*What are the chief signs, symptoms or complaints that forced you to turn to our Ayurveda Doctors?

General Diet

*Diet details

Complete History of Disease

*Does your disease symptoms increase or decrease when you change climatic zones?

*What kind of food, lifestyle or environmental changes relieves the symptoms of your disease and which ones trigger them?

Digestive System

How is your appetite and digestion?

*Write the complete details of your bowel movements, such as, time of evacuations, frequency, color, consistency, regularity, irregularity and smell.

Do you see any mucus in your stool?

Yes No

*How often do you have constipation and what do you think are the causes?

*Do you pass flatulence?

*Do you have hyperacidity?
*Do you feel heaviness, discomfort and pain in your stomach after eating?
Urinary System

*What is the frequency, quantity and color of your urine?

Do you feel any burning sensation while urinating?

Yes No
Sleep

Do you have sound sleep?

Mental Condition:

How would you rate yourself emotionally?


(press 'ctrl' and click for multiple selection)

*Describe your economical condition

Your Treatment History  

*What types of treatments and medicines have you taken so far?

*What have been the results?

*Have you observed any side effects?

*How much do you know about Ayurveda?

Reproductive System

Mention, if you have any sexual problem

Are there any other details you would like to mention?

Your Gynecological History (For female patients only)

Are you married?

At what age were you married?

 

Since how many years are you married?

 

How many children do you have? How old are they? 

Are you in the pre or post-menopausal phase of life?

What are your post-menopausal complaints? 

Are you currently on hormone replacement therapy (HRT)?

Would you like to have a safe Ayurvedic alternative to HRT?

How are your periods?

Do you want to give any other information?   

 * Essential Fields
  BENMOON PHARMA PRODUCTS
     
SPECIAL PRODUCTS
SIGN UP FOR NEWS LETTER
Add Remove
BENMOON TREATMENT
   
   
DOSHA EVALUTION
       
     
Know your Dosha Type
FREE CONSULTANCY
FREE Online Consultation from leading health care professionals in various specialties.
Send in your medical queries and get an opinion. You save your money and time. We guarantee the answer on your question in a 24 hours term.
  More  
SURVEY
Does health problems ruining your life?
Yes
No
[ Results ]
285 Votes