1. Please, describe in details your personal Health Complains
and general Symptoms: |
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2. Please, specify correctly your recent medical diagnosis
(if you were diagnosed). Please, specify if you have any particular abnormalities
in your blood test (if you had one): |
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3.Please, specify medical Treatment(s) which you were
taking before (including drugs and procedures). If yes, please, describe
how this Treatment(s) affected your Physical and Emotional Health: |
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4. Did you have any type of natural (alternative medical)
or Professional Homeopathic Treatment(s) before? If yes, please, describe
how this Treatment(s) affected your Physical and Emotional Health: |
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5. Please, clarify and describe if you have (had) any
particular Excretory Complains or/and Problems (liver, kidneys, bladder,
Gallbladder). Do you have Gall- or Kidney- Stones , Hepatitis, HIV, Cancer
or any type of the inner inflammatory problems? Please, describe your Symptoms
in details: |
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6. Please, clarify and describe if you have (had) any
particular Respiratory Complains or/and Problems (Sinus, Drip, Inner ear,
Bronchial tubes, Lungs, etc.) Do you have Asthma, Tuberculosis, Bronchitis,
respiratory Allergy, Sinusitis, Laryngitis, Inner ear infection, Cancer,
etc. Do you have any complains regarding Coughing (dry or with extensive
mucus, more extensive at the morning, evening or the night) , Sneezing,
nasal or sinus pain and tension, low hearing? Please describe your Symptoms
in details: |
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7. Please, clarify and describe if you have (had) any
Digestive Complains or/and Problems (Gums, Teeth, stomach, Pancreas, Bowels,
etc.). Do you have bleeding Gums, problems with Teeth (specify), Stomach
pain or internal bleedings, Diabetes or Hypoglycemia, irritable Bowels,
Gas, Heartburn, Colic, Constipation, Hemorrhoid, Overweight, Obesity, lack
of appetite, serious Poisons, etc.? Please describe your Symptoms in details: |
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8. Please, clarify and describe if you have (had) any
Circulatory Complains or/and Problems (Varicose veins, Spider veins, High
or Low Blood Pressure, Cerebral vascular problems, Heart attack, Stroke,
Heart transplantation, Atherosclerosis, etc . Do you have (had) irregular
Pulse (before of after an exercise), Extra systolic, Congestion, difficulties
to breath and pressure in the heart area (regularly, before or after an
exercise), cold feet and hands, easy nasal bleedings, easy bruises, dizziness,
etc.? Please, describe your Symptoms in details: |
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9. For Female Only.
Please, clarify and describe if you have (had) any reproductive Complains
or/and Problems (any particular genitals dysfunction, Fibroids, Cancer,
PMS, Frigidity, Leucorrhea, etc.). Do you have Periods irregularity, intensive
bleeding, Clots, painful breasts, PMS depression, Spotting, sleep problems
and over irritation during the Period, any infection of reproductive organs,
any inner inflammations or Pain, etc.? Are you on the Hormone Replacement
Therapy (HRP)? Please describe your Symptoms in details: |
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10. For Male Only.
Please, clarify and describe if you have (had) any reproductive complains
or/and Problems (Prostate Cancer, any genital infections, Testicle or Prostate
inflammation, etc.). Do you have (had) regular or irregular urination,
any particular surgery? Please, describe: |
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11. Please, clarify and describe if you have (had) any
Nerve Complains or/and Problems: Migraine, frequent Headaches, Sciatica,
Nervousness, Attention deficit disorder, Hyperactivity, Anxiety, Depression,
Back Pain, Tremor, Alzheimer's or Parkinson's Disease, Epilepsy, any Psychotic
reactions, Suicidal tendencies, Sleep problems, Very high Stress Level,
Night mares, Multiple Sclerosis, infectious Meningitis, etc. Please, describe
your Symptoms in details: |
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12. Please, clarify and describe if you have (had) any
Skin Complains or/and Problems: Acne, Eczema, Dermatitis, Psoriasis, Herpes,
Hives, Rash, Warts, Skin Allergy, Burns, Skin Eruptions, Phlebitis, Skin
Redness, Very dry Skin, Skin Cracking, Nipples Cracking, Fungus Infection,
Keloids, etc. Do you have (had) Itchy Skin, Skin pain and/or Inflammation.
In what places or areas of the Body? Please describe your Symptoms in Details: |
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13. Please, specify, if you have Arthritis, Rheumatoid
Arthritis, Bone Cancer, Bone Tuberculosis, Bone transplants, Hair Loss
(Baldness, Alopecia, Fungus infection, Dandruff), Nails problems, Tooth
problems, Silver fillings, Injury, etc. : |
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14. Please, specify if you have any Muscular Complains
or/and Problems: Muscular pain, muscular stretching, Paralysis, etc. Describe
your Symptoms: |
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15. Please, describe your personal temperament using
the appropriate following key phrases: Impulsive, Irritable, easy angered,
angry when contradicted, prone to contradict, changeable and inconsistent,
jealous, suspicious, critical, ambitious, egotistical, pessimistic, anxious
and indecisive, lack of confidence, tend to theorize, conscientious about
trivial matters, concerned with precision/accuracy, fastidious, anxious
in company, tend to worry about everything, passive, think rapidly, think
slowly, vain, dislike being touched, anxious about own health, talkative
and frequently change subject, Low sex drive, affectionate, anxious about
own health, sympathetic, like sympathy, dislike sympathy, moved to tears
by music, cry readily, cry from anxiety, optimistic, hyperactive, have
lack of attention, can not concentrate easy, like permanent motion, like
rest and loneliness, like big company, like intellectual talk, like to
share time with your kids, easy irritated by kid's: |
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16. Please, describe your Food preferences using the
appropriate following key phrases: like warm food and drinks, dislike warm
food, like raw foods, loss appetite during menstruation, like eggs (boiled),
dislike eggs, like fruits , dislike fruits, like starchy food, like bananas,
dislike to mix of foods, eat to bursting point, like ice cream, like fatty
food, like bread and butter, like sweet foods, dislike sweet foods, like
cheese, like olive oil, like salty foods, dislike salty foods, like oysters,
dislike fish, like lemons, like pickles, dislike tomatoes, like spicy foods,
dislike garlic, like garlic , dislike onions, like or dislike milk an diary
products, like alcohol, little thirst, like or dislike coffee, like or
dislike hot drinks: |
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17. Please, describe if you have any of following Fears:
heights, enclosed spaces, public places, mice, snakes, water, thunderstorms,
sharp needles, ghosts, darkness, being alone, being late, being hurt emotionally,
be poisoned by bad food or pollution, illness, insanity, cancer, death,
for the health of your family, failure in business, poverty, loss of self-control: |
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18.Do your Physical Complains and Health Ailments are
worse: in cold or warm dry, windy or wet weather? Are you sensitive to
any smell or noise? During what time of the day you usually feel better
and worse? |
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