Punarvasu Ayurved's Online Consultation Form

Punarvasu Ayurved's Online Consultation Form

Advanced Ayurved Diagnosis Tool Form Preview
    • Basic Information  
    • Main Case Paper  
    • Routine ( Dinacharya )  

    • Detail Routine ( Detail Dinacharya )  
    •   Daily weekly sometime Never
      Hotelling
      Chinese
      Curd
      Pickle
      Papad
      Flakes ( Poha)
      Fried Food
      Sprouted Food
      Bakery Products
      Misal / Vada-paav / Samosa / Kachori etc.
      Fermented Food (Idli/ Dosa/Uttapa etc.)
      Gram Food ( Besan Atta Foods)
      Bhel / Panipuri / Ragada pattis etc.
      Stale Food ( Baansi Cheeze)
      Milk Products
      Sago ( Saabudaanaa)
      Fasting ( Langhan / Upvaas)
      Raw Food (Uncooked Food)
      Nonveg
    •   Yes No Sometimes
      Do you visit Toilet Daily
      Do you have feeling of Daefication
      Do you need Tea / Coffee / other things for Sensation


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    • Gyanaecology - Fields for Female Patients Only  

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