Pre-Consultation Information Form

Dynamocure Homeopathic Multi-speciality Centre

Email: dynamocureclinic@gmail.com

Website: https://drajaz.com

Patient Case Record

Important Information :

Dynamocure Homeopathic Multi Speciality Centre me har patient ko honest, ethical aur compassionate medical guidance di jati hai.

Homeopathy me treatment sirf disease ke naam ke basis par nahi diya jata, balki patient ki physical health, mental aur emotional state, lifestyle, medical history, stress pattern aur individual body response ko samajhkar personalized treatment plan select kiya jata hai. Isi wajah se pehli consultation me detailed case taking ki jati hai.

Kuch sawal aapko directly current problem se related na lagein, lekin unka purpose aapki overall health ko holistically samajhna hota hai, taaki aapke liye sabse suitable treatment approach choose ki ja sake.

Hum kisi bhi tarah ki false assurance, instant result ya 100% cure guarantee nahi dete, kyunki har patient ka response medicines, diet, lifestyle, stress level, work , environment aur follow-up compliance ke hisaab se alag ho sakta hai. Zarurat padne par treatment plan ko patient ki progress ke according modify ya adjust bhi kiya ja sakta hai.

Aapki saari personal aur medical information strictly confidential rakhi jati hai. Agar kisi sawal ka jawab dene me aap uncomfortable feel karte hain, to aap consultation ke dauran directly doctor ko inform kar sakte hain.

Note:

Agar kuch sawalon ka jawab yaad na ho to unhe skip kar sakte hain.

Consultation se pehle apni symptoms aur important points paper ya mobile notes me likh kar rakh sakte hain.

Purani reports, test results aur prescriptions date-wise arrange karke laayein — latest reports upar rakhein.

• PERSONAL DETAILS
• 1. Name:
• 2. Age / Sex:
• 3. Single / Married / Widow / Divorced:
• 4. Contact Number (especially WhatsApp number)
• 5. Occupation:Kya kaam karte hain?Kya aap apne kaam se satisfied hain?
• 6. Address:Kahan rehte hain? Wahan ka environment aur log aapko comfortable lagte hain?
• 7. Reference:Aapko hamare clinic ke bare me kaise pata chala?

• PART 1 : CURRENT COMPLAINT
• Aapki present takleef ke bare me
  • Aapko kya problem hai?
  • Kab se hai?
  • Aapke hisaab se kis wajah se shuru hui?
  • Achanak hui ya dheere dheere?
  • Koi treatment ya medicine li thi?
  • Takleef waise hi hai ya kam-zyada hoti rehti hai?
  • Takleef kis tarah hoti hai?
  • Body ke kis side ya kis jagah par hoti hai?
  • Kis cheez se araam milta hai? Rest, pressure, garam/thanda, position, mausam, time etc.
  • Kis cheez se takleef badh jati hai? Movement, weather, food, stress, position etc.
  • Koi aur symptom saath me hota hai?
• PART 2 : PAST HISTORY
• Pahle hui bimari ke bare me
  • 1. Kya yeh problem pehle bhi hui thi?
  • Agar haan, to treatment liya tha?
  • Kya Kis treatment se araam mila tha ya recurrent ho raha hai ?
  • 2. Kya pehle se koi aur bimari hai ?
  • Jisse Sugar ; BP ; Thyroid; BP ; Asthma ; TB ; Cancer ; HIV/AIDS ya koi bhi jo apko pata hai ? agar haa to Kya abhi uske liye koi regular medicines chal rahi hain?
  • 3. Kya kabhi skin disease hui thi ? jaise ke Daad, khaaj , Khujli , Allergy , Pitti , Safed daag etc.Kya uske liye cream/ointment use kiya tha?
  • 5. Kya koi operation hua hai ? Jaise Appendix , Hernia , Piles , Warts , Corn removal etc.
• PART 3 : FAMILY HISTORY
• Khandan me chalne wali bimariyan :
• Kya aapke family me kisi ko yeh bimariyan rahi hain? Jaise TB , Cancer , Diabetes (Sugar) , BP ( hypertension) , Thyroid , Heart disease / Heart attack , Gathiya (arthritis) , Safed daag ( vitiligo) , Mental illness , Asthma / Allergy etc.
• PART 4 : STRESS / EMOTIONAL FACTORS
• Kya koi baat aapko mentally disturb karti hai?
  • jaise kisi cheez se darr? Andhera, janwar, disease, death etc.
  • Koi chinta? Ghar, bacche, paisa, relationship, job etc.
  • Kya jaldi ghabrahat hoti hai?
  • Kya kisi baat ka gussa ya dukh andar rehta hai?
  • Kya koi emotional problem ka asar aapki health ya daily life par pad raha hai?-
• PART 5 : GENERAL INFORMATION
• ADDICTION / NASHA :
• Kya kisi cheez ki habit ya addiction hai?
  • Jaise Chai , Coffee , Gutkha , Paan , Bidi , Cigarette , Alcohol , Ganja , Drugs ya aur kuch
• SLEEP :
• Neend kaisi rehti hai?
• Sound sleep ya disturb?
• Kis position me sote hain?
  • Right side , Left side , Ulta , Seedha , etc
• Sapne aate hain?
• THERMAL NATURE
• 1. Kaunsa mausam zyada pasand hai?Garmi , Thandi , Baarish Kyu?
• 2. Kaunsa mausam suit nahi karta?
• 3. AC/Fan ka use kaise karte hain? AC temperature ya Fan speed
• 4. Blanket lekar sote hain? Thand ki wajah se ya habit se?
• 5. Nahane ke liye kis type ka pani pasand hai? Garam , Thanda , Normal
• APPETITE / BHOOK
• Bhook kaisi lagti hai?
• Kis time zyada bhook lagti hai?
• Kitna khane par pet bhar jata hai?
• CRAVING & AVERSION
• Kaunsa taste khane ya peene me pasand aata hai ya khaane ka dil karta hai ?
• Kaunsa taste khane ya peene me bilkul pasand nahi aata hai ya dekh kar mood off ho jata hai ?
  • Jaise Meetha , Khatta , Theekha , Masaledar ya Fried food, Chicken , Mutton , Fish , Milk , Curd , Chocolate , Cold drinks etc.
• THIRST / PYAAS
• Kya baar baar pyas lagti hai?
• Garmi ya mehnat ke baad bhi?
• Kaunsa pani prefer karte hain?
  • Thanda , Garam , Normal
• Pani sip sip karke peete hain ya ek saath?—
• PART 6 : MIND
• Emotions
• Aapka mood zyada tar kaisa rehta hai?
  • Khush , Udaas , Gussa , Chidchidapan etc.
• Sabse zyada tension kis baat ki rehti hai?
• Koi baat dil par jaldi lagti hai?
• Tension me kya karte hain?
• Sympathy ya tasalli milne se achha lagta hai
• Intellect /Thinking Pattern
• Memory aur concentration kaisa hai?
• Decision lene me confusion hota hai?
• Kya overthinking hoti hai?
• Kya cheezein bhool jate hain?
• Will Power / Nature
• Energy aur kaam karne ka mann kaisa rehta hai?
• Kaam turant karte hain ya delay?
• Mushkil waqt me himmat rakhte hain ya jaldi haar maan lete hain?
• Akela rehna pasand hai ya logon ke saath?

Thanks & Regards

• Dr. Ajaz Ahmad Khan
• BHMS & CCMP (MUHS) PG-D-EMS (TISS) MCH Regd. 65854
• Managing Director :
• Dynamocure Homeopathic Multi-speciality Centre
• Website: https://drajaz.com