Vishvanand Ayurved's Online Consultation Form

Vishvanand Ayurved's Online Consultation Form

For Ayuredic Diagnosis Form Preview

  • Click on Below Heading To Proceed. Every Fields Under Each Headings are Required to be filled except Gyanaecological History
    • Basic Information  
    • Main Case Paper  
    • My Routine ( Dincharya )  

    •   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)
    •   Yes No Sometimes
      Do you visit Toilet Daily
      Do you have feeling of Daefication
      Do you need Tea / Coffee / other things for Sensation


    •    
    • Gyanecological History  

    • Finalise your Submission  
    • Upload a File
    •  
    • Should be Empty: