Dr R S Saini - Homeopathic Treatment for Hair loss, Psoriasis, Vitiligo, Acne, Alopecia, Asthma, etc. Opt for Homeopathy treatment

Your Name *

Your Age *

Your Gender *

Phone Number *

Your Email *

Your Profession

Address

Country *

Brief Description Of The Problem *

How do you cope with the disease i.e., what the disease forces you to do ? *

Do you ever think about your disease or not? If Yes what is the thought process? *

Write about your nature in general? *

Any change in moods during the sickness, Please explain ? *

How do you handle your anger?*

Liking for Music? *

Please Explain Your Likes/ Dislikes or any Sensitivity to Food? (eg. spicy, oily, fatty, eggs, fish etc)*

Which weather your body can tolerate? (e.g. hot or cold)*

YOUR APPETITE, THIRST, SLEEP & BOWL MOVEMENT. PLEASE EXPLAIN.*

Menstrual History (In case of Females)?

Any other Information or Symptom which you feel is relevant & connected with the main disease

Problems, If any, during previous Pregnancy?

In case of problems of children, mothers please write what was your mental state during the period of pregnancy?

Please write about your Negative Emotions, if any, as they will help in the selection of the appropriate remedy?*

How did you spend your childhood ? Did you get the love, care and nurturing from the parents ? *

HOW DID YOU SPEND YOUR SCHOOL/COLLEGE/UNIVERSITY DAYS? PLEASE ELABORATE*

Were you good at making friends or felt friendless? *

Did you face any teasing, jesting, racial remarks or mocking from any one at any stage of your life? *

In the area of relationships , did you ever feel bothered by any relation. If so how? What kind? *

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