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Health Data Questionnaire
Health Data Questionnaire
Name
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Age
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Gender
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Blood pressure
Weight
Present health problems if any:
Onset
Aetiology
Course of the disease
Clinical features
Predisposing factors if any
Diagnosis of the present health condition by a Doctor
Treatment History
Patient History
Family History
Relevant information you think might be helpful:
Any previous experience with Ayurveda therapies / programs?
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