Enquiry Form

General Health Condition

Sex
Diabetic
H.BP/L.BP
High Cholesterol

Details about Motion and Urine

Motion

Daily
Nature
Constipation
It is
Motion with

Urine

Color
It is
It is
Foul Smell
H. Oil Use
Oil Bath
Meals Habit
Sleep

Sexual Activity - For men

Organs
Masturbation

Infertility - for Women

Menses Cycle
Bleeding
Colour
Stain on Cloths
Foul Smell
White Discharge
Inflammation
Pain
Prolapse of the Uterus
Spotting
Laproscopy done
Scanning
Uterus Size
Ovary Size
Fallopian Tube
Abortion
Any illness with past six months

Family History

Is this a Herditary
General Information
Pulse Condition
Clinical Test