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