ONLINE CONSULTANCY


The Company also provides facility for online consulting, enabling patients to avail treatment/medical advice by sitting at their home/office, anywhere it is. Online enquiries are well received by patients and their queries are replied to, on daily basis. Further, suitable medications will also be provided to needy patients, through courier.

Ayurveda treatments for your ailments are just a click away now, in Sanjeevani.
 





 

Personal Details

First Name

Middle name

Last Name

Address

Nationality

Date on birth

Height (cm)

Weight (kg)

Sex

Profession

Occupation

E-mail address

Telephone #

Fax #

Marital status

Children

Present Illness
Symptoms with duration

Past History – Disease & Treatment
Symptoms with duration & Treatments taken
Details of Previous Diagnosis (if any)
Details of Previous Investigations (if any)
Do you have any of the following? If yes details
Diabetes Mellitus
High BP
Allergies
Family history of any disease
On any medication? Details (Dose, How Long etc.)
Personal History
Sleep
Appetite
Bowel Habits
Urination
Addicted to Tobacco / Alcohol / Drugs
Present diet -Veg/ Non Veg/ Mixed
Menstrual History

 
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