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DISEASE CATEGORY
01. Disease of Eye
02. Disease of Ear
03. Disease of Nose
04. Disease of Mouth
05. Spine
06. Frozen Shoulder and pain, Brachial Neuritis
07. Heart
08. Skeletal and Muscular Diseases
09. Respiratory Diseases
10. Digestive Diorders
11. Kidney
12. Gynic Disease
13. Male Diseases
14. Nervous System Disease
15. Mentaly
16. Weight Relative Problem
17. Hair Problem
18. Endocrine Glands


Comments
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  *Required Fields
Disease Name : Thymus Gland
Name :
Sex : Male Female
*Father's / Husband's / Guardian's Name :
*Address :
*City / Town :
*State :
*Country
*E-mail :
Example: acupressure@dataone.in
*Contact No.:
Occupation:
Age:
Birth Date :
Weight :
Disease/Complaints/Pain/Problem :
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Sleep : Disturbed
Sound
With Dreams
Urine & in day :  ( times )
Pain: before
during
after
Urine & in night :  ( times )
Pain: before
during
after
Stool/Feces : Normal
Constipation
Hard
Loose
Hunger :
Thirst : Normal
More
Less
Taste : Sour
Sweet
Salty
Menstrual Cycle : Clots
Scanty
Excess
Normal
Attitude : Grumpy
Sprightly
Concerned
Depressed
Fearful
Habit :
Past/Family History :
Pathology :
B.P. :
Clinical Examination/Investigation Report :
Other Report :
Diagnosist :
Treatment undergoing at present :
I myself come for treatment on my own responsibility. Doctors & Institute are not responsible for any cause.

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