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    Please provide detailed information about your complaint and specify all the symptoms pertaining to your health. Try to incorporate following details to describe your problems:

    When the symptoms appeared? (for instance six months or a year back etc.)
    What is the general condition at present?
    Weight?
    Activity?
    Pain (for instance pain started from and goes to a particular point)?
    Location of the pain?
    If some how you get some headache or pain around your body which side of your body is mostly affected? Right or Left?
    Desire to work? Yes or No. If yes then why & what (household work, office work, general or variety cooking)? If NO, then why?
    Any Spot/Pigmentation/Rash/on the body? Which parts of your body are involved? How big or small is the spot/Pigmentation?
    Please tell us how all complaints started and the progression of symptoms?
    When & how disease was diagnosed?
    Please tell if you think your problem started due to some specific reason or under certain circumstances, such as exposure to certain Chemical, after taking any medicines, due to some stressful situation (for instance set-Back in life, loss of close relative, work pressure, any stress due to pregnancy or illness at time of Pregnancy). If you feel any other reason not mentioned above, kindly specify?
    Associated complaints (if any)?
    In this section, please describe if you have any other complaint not asked or mentioned above in detail including when and how it started and since when you are suffering? Duration of disease?

    General information about you:-

    Temperature tolerance -Thermals
    Which weather you like most?
    Appetite
    Cravings if any
    Aversion if any?
    Thirst
    Water intake You feel thirsty often/less thirst/only with meals? How many glasses per day-
    Sweetness
    Bowel Habits
    Urination

    For Females only

    Menses

    For Females only Any abortion (Induced, Natural)

    Pregnancy History
    Any Vaccination?
    How were you keeping as a student with teachers and classmates?
    Were they (parents, teachers, classmates or anyone else) strict with you or very disciplined? Were you allowed to o what you wanted todo OR were you pampered?
    How much you use to socialize (extrovert) or very particular in choosing friends?
    What were you most sensitive about during your childhood? (eg. Respect, Criticism, others laughing at you etc.)
    How were you like to dress up during your childhood?
    Who were your friends? More of Males or Females? (Names not required)
    In this section, please describe if you have any other complaint not asked or mentioned above in detail including when and how it started and since when you are suffering? Duration of disease?

    General information about you:-

    Your physical appearance
    Senses
    Hearing (1) Can you hear quite sharp?
    (2) Can you tolerate noise or any sudden noise? (3) If no what type of noise disturbs you the most if possible explain.
    Vision - Have you find any change in your vision (Any blurring or something else)?
    Smell (1) Is your smelling power is very sharp? (2) Can you tolerate any odor (strong or bad)? (3) If no what happens with it?
    Taste (for females only) Any change in taste after delivery since the bleeding had started?
    Any other information that wish to share in relation to your senses?
    Memory
    Any change you observed with your memory (any forgetfulness etc.)?

    Young Adult

    How are your terms with your Spouse & In-laws (IF MARRIED) & with your Parents?
    How do you consider yourself as a social person, as a homely person, as a Son/Brother/Husband/Father or Daughter/Sister/Wife & Mother?
    How regular ur in going to ur office & why (is it money, bored at home, u like freedom, or something else)?
    How much particular you are in keeping ur things and why?
    What you are most sensitive to?
    Are you much of a socializing person?

    Senses

    Hearing (1) Can you hear quite sharp?
    (2) Can you tolerate noise or any sudden noise? (3) If no what type of noise disturbs you the most if possible explain.
    Vision - Have you find any change in your vision (Any blurring or some thing else)?
    Smell (1) Is your smelling power is very sharp? (2) Can you tolerate any odor (strong or bad)? (3) If no what happens with it?
    Taste (for females only) Any change in taste after delivery since the bleeding had started?
    Any other information that wish to share in relation to your senses?

    Memory

    Any change you observed with your memory (any forgetfulness etc.)?
    What are your hobbies?
    Can you take your own decisions?

    Desire

    Things which you love to have any particular craving?( like fruits, juices, lemon)
    How about sex life, your desires?
    ANYTHING ELSE APART FROM ABOVE WOULD YOU LIKE TO ADD?