FOR RESEARCH FORM SEE BELOW
LIST OF VETERINARY HOMEOPATHIC MANUFACTURERS – WEB SEARCH
1. Anifarm Products,
Exporters of contemporary veterinary biochemic formulations.
A/4 Rajanigandha,
Pune,
Maharashtra, India, 411 016.
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2. Goel Vet Pharma
Manufacturer and supplier of homeopathic veterinary medicines such as canasule, diasule, equasule, foomasule, fertisule, henjai, hit-o-gen, hemisept, milkogen, mandgole, pyrosule, rheumasule, treatasule, uterogen and uterosule.
Address: 102, Agarwal Complex,
Phone: +(91)-(121)-2530749/3202736/2400859 Fax: +(91)-(121)-2520119/3202736
Website: http://www.indiamart.com/goelvetpharma
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3. N. P. Dutta & Sons
Engaged in manufacturing and exporting homeopathic drugs, homeopathic medicines, homeopathic veterinary medicines, dilution and mother-tincture.
Address: 26,
Phone: +(91)-(33)-22428035 Fax: +(91)-(33)-22316010
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LIST OF HOMEOPATHIC MANUFACTURERS – WEB SEARCH
1. Agrawal Homoeo Hall,
Manufacturer / Supplier / Exporter of : Homeopathic Products, Homeopathic Medicines, Homeopathic Drugs
229,
Dehradun,
Phone: +(91)-(135)-2652524 Fax: +(91)-(135)-2652524
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2. Alfa Medicare Homoeopathic Pharmacy,
Manufacturer / Supplier / Exporter of : Homeopathic Medicine
1/37, Kedy Shopping Centre,
Mumbai,
Phone: +(91)-(22)-23090532
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3. AL-Kowzer Exports
Manufacturer and exporters of homeopathic medicines.
Address: 65B/1, Periyar Nagar, Dindigul - 624 001,
Phone: +(91)-(451)-402413/420695 Fax: +(91)-(451)-438070/437063
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4. Allen Pharmaceuticals Pvt. Ltd.,
Address: 1/5, Sanvid Nagar, Sakat Side Road, Indore-452 00l.
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5. American Homoeo Pharmacy,
Address: Trichur.
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6. Anand Homoeopathic Medical College & Research Institute,
Address:
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7. Annai Bio- Crop Private Limited
Manufacturers of jatropha curcas.
Address: 19/4,
Phone: +(91)-(44)-42101596 Fax: +(91)-(44)-42101596
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8. Apex
Manufacturers and exporters of all types of medical surgical instruments and Medicines,herbal products, ayurvedic and Homeopathic Medicines.
7/195, Goregaon Ambica Society,
Mumbai,
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9. Bakson Drugs & Pharmaceuticals Pvt. Ltd.,
F-64, Okhla Industrial Area, Phase I, New Delhi-110020
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10. P. Banerjee,
Mehijam, Santhal Parganas,
109, D.Shyama prasad
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11.
Manufacturers of homeopathic medicines for various treatment.
84/1, Second Cross, Second
Phone: +(91)-(80)-23123020 Fax: +(91)-(80)-23123020
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12. Beck & Koll,
Plot No 37 A, Government Industrial Estate, Kandivali (West) Mumbai-400067.
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13. Benzers & Taffels,
L/56, Narankari Colony, Delhi-ll0009.
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147. Bhandari Homeopathic Laboratories
Manufacture and export of homeopathic medicines, homeopathic drugs, mother tinctures, herbal extracts, homeopathic dilutions, hard & soft lactose tablets, handmade sugar pellets, herbal granules, organic preparations, herbal ointments and herbal gels.
Address: DLF Industrial Estate No.1,
Phone: +(91)-(129)-2275738 Fax: +(91)-(129)-2275738/26223643
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15. Bhandari Homeopaths Pvt Ltd
Address: GI-679 Industrial Area, Bhiwadi 301019,
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16. Bharat Homoeo Pharmacy Ltd.,
Address: Post Box 85, 20/60, Ashok Marg,Lucknow-l.
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17. R. S. Bhargava Pharmacy
Manufacturers and exporters of homeopathic and biochemic medicines like complex tablets, eye products, ethical products, homeopathic triturations etc.
Address: 115-A, 2nd Floor, Hari Nagar Ashram Chowk,
Phone: +(91)-(11)-26343568/26343691/26341058 Fax: +(91)-(11)-26343580
P.O. Bhargava Pharmacy, Anupshahar, Bhulandshahar U.P.
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18. Bhartiya Pharmaceuticals,
Address: 8A, Central Market, Lajpat Nagar, New Delhi.110024
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19. Bhattacharya & Co (P) Ltd.,
Address: 73,
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20. Bio-India Pharma Private Limited
Manufacturers and exporters of ranges of homoeopathic medicines.
Address: Shivam, 39/2023, 2018, Gandhinagar, Bandra (East), Mumbai - 400 051,
Phone: +(91)-(22)-55767133 Fax: +(91)-(22)-26557301
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21. Boericke Homoeo Pharmacy,
85,
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22. Bohala Pharmaceuticals, Homoeopathic Pharmacist,
21, Gandhi Nagar, Kumbakonam Distt. Thanivur, Tamilnadu.
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23. Care n cure Pharma,
Manufacturer / Supplier / Exporter of : Homeopathic Medicines, allopathic Medicines
373A , East Mohan Nagar,
Phone: +(91)-(183)-2580059
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24. Century Containers Private Limited
Manufacturer / Supplier / Exporter of : Hdpe Containers, Injection Molded Caps, Sweets Packing Containers, Auto Blow Molded Parts, Irrigation Plastic Parts, Homeopathic Medicines
Address: 322, Modern Industrial Estate, Bahadurgarh - 124 507,
Phone: +(91)-(1276)-267782
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25. Champak lal magan Lal Homoeo Pharmacy,
Address: 41/43, Vithalvadi Industrial Area,
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26. S. Chaudhary & Co.,
Address: 43/1,
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27. Chemmanur Clinic & Laboratory,
Address: Chorghat, Kerala..
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28. Ci Bi Herbal Exporters Link
Manufacturers and exporters of herbal medicine.
Address: 12 C, 4th Cross, Vadavalli,
Phone: +(91)-(427)-446069
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29. Dr. De Chane’s Homoeo Division,
Address:
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30. Doliosis Homoeo Pharma Private Limited
Manufacturing of homeopathic medicines, tonics, syrups, liquid complexes etc.
Address: S. No. 1073/6, Pirangut Tal Mulshi, Pune - 412 111,
Phone: +(91)-(20)-22923158 Fax: +(91)-(20)-22923159
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31. Duke Pharmaceuticals,
404,
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32. N. P. Dutta & Sons
Engaged in manufacturing and exporting homeopathic drugs, homeopathic medicines, homeopathic veterinary medicines, dilution and mother-tincture.
Address: 26,
Phone: +(91)-(33)-22428035 Fax: +(91)-(33)-22316010
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33. Economic Homoeo Pharmacy,
89,
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34. Everest Homoeo Laboratory,
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35. Evergreen International,
Manufacturer / Supplier / Exporter of : Medicines, pharmaceuticals, Homeopathic Medicines
A-305, Defence Colony,
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36. Excel Pharma
Manufacturers of homeopathic medicines.
Address: Plot No. 20, Industrial Area Phase-1,
Phone: +(91)-(172)-5009675
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37. Garg Medicos,
Manufacturer / Supplier / Exporter of : surgical items.,ayurvedic Medicines, allopathic Medicines, Homeopathic Medicines, cosmetic Medicines, drugs
F-1/500, Sultanpuri,
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38.
K-6-139, A. Balamatta, Kanakanady,
Padil, Mangalore-575007.
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39. Goel Homoeo Pharma
Manufacturers of homeopathic medicines.
Address: A-7, Nagar Palika Industrial Area,
Phone: +(91)-(1472)-325333 Fax: +(91)-(1472)-240635
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40. Hahnemann Laboratory.
Address: 285, Bipin Bihari,
Address: 13,
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41. Hahnemann Pharmaceutical Laboratory,
Address: P-4,
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42. Hahnemann Pharmaceuticals,
Address: Phase I, Naraina Industrial Area, New Delhi-ll0028.
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43. Hahnemann Publishing Co.
Address: 165, Bipin Bihari,
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44. Hahnemann Pure Drug Co. Private Limited
Engaged in manufacturing mensol ladies tonic, ferrocin drop, gastorin syrup, calendula plus and aqui plus.
Address: D-13, Sector 63, Noida - 201 307,
Azamgarh U.P.
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45. Hahnemann Scientific Laboratory,
Address: 2, Subash Marg,
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46. Hamd Herbals Private Limited
Manufacturers and exporters of all types of homoeopathic globules and soaps.
Address: Corner Of Modi No.:3,
Phone: +(91)-(712)-2521105 Fax: +(91)-(712)-2537350
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47. Harjeet Enterprises,
Address: 22 E/A, Industrial Area, Panipat, Haryana.
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48. Himani Limited,
Address: 13,
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50. Holistic Remedies Private Limited
Manufacturer and bulk exporter of homoeopathic medicines, dilutions mothertinture and ointments.
Address: Anand Warehouse, 15 (4), Mumbai Cotton Mills Estate, T. B. Kadam Marg, Kalachowki, Mumbai - 400 033,
Phone: +(91)-(22)-23750852/23715385 Fax: +(91)-(22)-23744707
10, Mohtar House, 36,
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51. Homeo Care
Manufacturer / Supplier / Exporter of : Homeopathic Treatment, Homeopathic Medicines
A-1/190, Sector-16, Rohini,
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52. Homoeo Research Institute,
138, V.N. Marg,
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53. Homoeopathic Research Institute,
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54. H. P. Group
Manufacturer / Supplier / Exporter of : Biochemic Medicines, Mother Tinctures, Cough Syrup, Liver Tonic, Homeopathic Dilutions,Anti Inflammatory Medicine, Homeopathy Tablet, Anti Fungal Cream, Diabetes Tablet, Headache Tablet
IInd Floor,
Phone: +(91)-(261)-2456816/2400110 Fax: +(91)-(261)-2451905
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55.
Manufacturers of homoeopathic medecines.
Address: Purar Phata, Mangaon, Raigad, 134/16 Behind
Phone: +(91)-(22)-26505627 Fax: +(91)-(22)-986 986 4903
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56. Indian Drugs and Botanical Herbs Co.,
Manufacturer / Supplier / Exporter of : Herbal Medicines, Herbal Extracts, Natural Essential Oil, Gum, Resin,Crude Drugs,Homeopathic Medicines,Raw Medicinal Herbs, Medicinal Seeds, Dried Flowers, Medicinal Plants, Medicinal Roots
103, Ram Nagar, Krishan Nagar Post Box No 9416,
Phone: +(91)-(11)-23992345 Fax: +(91)-(11)-23953182
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57. International Homoeo Research,
1,
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58. J & J. Dechane Laboratories Private Limited
Manufacturer / Supplier / Exporter of homeopathic medicines like agarco, amyglia, auratinum, zaher-co etc.
Address: 4-1-324, Residency Road, Troop Bazar-1,
Phone: +(91)-(40)-24753537/24753538/24753539 Fax: +(91)-(40)-24753131
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59. Jigar Pharmaceuticals,
Manufacturer / Supplier / Exporter of : Herbal Medicines,Bulk Drugs, Pharmaceutical Drugs, Pharmaceutical Bulk Drugs, Homeopathic Medicines
Near. Patel Guest House,
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60. J. V. H. Solutions,
Manufacturer / Supplier / Exporter of : Homeopathic Medicines, Health Care Homeopathic Product, Homeopathic Health Care Product
Secunderabad,
Phone: +(91)-(93)-47059386
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61. K.M.P. Oil Industries Ltd.,
Address: KMP Nagar, Cochin-682 006.
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62. Kadyan Overseas
Manufacturers and suppliers of homeopathic medicines, homoeopathic medicine for diabetes, homoeopathic medicine for blood pressure for heart diseases. Also sells herbal hair oil, herbal eye drops and herbla face pack. Packaging Materials For Homeopathic Medicines
Address: Near
Phone: +(91)-(180)-2575350 Fax: +(91)-(180)-2575418
Website: http://www.indiamart.com/kadyanoverseas
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63. King & Company,
90/6-A,
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64. Kothiwal Traders,
Manufacturer / Supplier / Exporter of : Homeopathic Medicines
24/147, Plazza Kalpana 3f / 2, Birhana Road, Kanpur,
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65. Lord Hahnemann Laboratory,
7,
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66. Lord’s Homoeopathic Laboratory Pvt Ltd,
C-106/5, Naraina Industrial Area Phase 1, New Delhi-ll0028.
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67. Lord Homoeopathic Pharmacy,
B-49, Naraina Industrial Estate, New Delhi-ll0028.
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68. M. K. Pharma,
Manufacturers and exporters of Homeopathic Medicines.
A-39, Priyadarshini Nagar,
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69. Master Homoeo Research Laboratory
Manufacturers of homeopathic anti-dandruff, hair conditioner.
M I G 65, Opp Zilla Parishad Colony, O Z P Colony, Srikakulam - 532 001,
Phone: +(91)-(8942)-225152 Fax: +(91)-(8942)-225152
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70. Mayon Pharmaceuticals
Manufacturers and exporters of homoeopathic, herbal medicines.
Address: Near Itwari Railway Station,
Phone: +(91)-(712)-2765296 Fax: +(91)-(712)-2765296
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71. Medisynth C. H. Private Limited
Manufacturers and exporters of homeopathic medicines.
Address: D-282, T. T,. C. MIDC Area , Turbhe, Mumbai - 400 705,
Phone: +(91)-(22)-27681116 Fax: +(91)-(22)-27682018
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72.
Address: 773-D, Sotiganj,
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73. Father Mullori Homoeopathic Poor Dispensary,
Address: Post Box 50l, Kankandy, Mangalore.
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74. Nagesh Homeo Pharmacy
Manufacturers of homeopathic medicines and many other homeopathy products.
209, Shanta Industrial Estate, I. B Patel Marg, Goregoan (E), Mumbai - 400 063,
Phone: +(91)-(22)-26852037 Fax: +(91)-(22)-26852707
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75. National Homoeo Laboratory,
110,
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76. New Era Homoeopathic Pharmacy (P) Ltd.,
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77. New Evergreen Store
Manufacturer / Supplier / Exporter of : ayurvedic Medicines,handicrafts,allophathic Medicines,Homeopathic Medicines
4, Defence Colony Market,
Phone: +(91)-(11)-24333475 Fax: +(91)-(11)-41552199
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78. New Life Laboratories Private Limited
Manufacturers and exporters of all types of homeopathic medicines
Address: 16,
Phone: +(91)-(755)-5240853/2548654 Fax: +(91)-(755)-2548654
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79. NVS Bio Research Private limited
Engaged in supply of homeopathic medicines, herbal medicines, ayurvedic medicines, unani medicines and mineral medicines as per ICH-GCP guidelines.
Address:
Phone: +(91)-(591)-2320327/3299122 Website: http://www.indiamart.com/nvschemicals
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80. Parul Homoeo Laboratory P. Limited
Manufacturers and exporters of various types of homoeopathic medecine.
Address: 108/90-A, Durga Devi Marg,
Phone: +(91)-(512)-2542041/2551132 Fax: +(91)-(512)-2551132
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81. Powell Homoeo Research Laboratory,
Address:
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82. Dr. Prakashan Homoeopathic Pharmacy Pvt. Ltd.,
Address: 11/640 A, Chelannur,
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83. Ram
Address: L-23l, Katedon Industrial Complex,
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84. Reliable Homoeo Pharmacy,
Address: Sabji Bagh, Patna-4.
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85. Roy & Co.,
Address: 176,
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86. Roy Choudhary & Co.,
Address: 135,
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87. Sagar Homoeo Stores
Manufacturers and exporters of homeo medicines like mother tinctures and dilutions.
Address: Opposite To
Phone: +(91)-(40)-3733430
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88. Saha Homoeo Clinic,
Manufacturer / Supplier / Exporter of : Homeopathic Medicines
P. O. Tulshihata, Malda, West
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89. Salax Chemicals Private Limited
Manufacturers and exporters of homoeopathic medicines.
Address: 179/1-7, Barood Khana, Golaganj,
Phone: +(91)-(522)-2229922 Fax: +(91)-(522)-2224563
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90. Sareen Homoeo Laboratories,
Address: Court Road, Jagadhari-l35 003 (Haryana).
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91. Savi Health Care Private Limited
Manufacturer and exporter of all kinds of homeopathic medicines.
Address: Shivneri 25/205, Nigdi Pradhikaran, Pune - 411 044,
Phone: +(91)-(20)-27652827 Fax: +(91)-(20)-27659828
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92. SBL Private Limited
Manufacturers and exporters of homeopathic and herbal medicines.
SBL House 2, Commercial Complex, Shrestha Vihar,
Phone: +(91)-(11)-2161935/2161934/22165145 Fax: +(91)-(11)-22162353
A-3, Site IV, Sahibabad, Ghaziabad-201010.
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93. Shanti & Shanti Homoeopaths
Manufacturers of homoeopathic medicines and exporters of homoeo products like mother tintures, dilutions, patents medicines etc.
Shanti Homoeo Stores, 6-1-91/34, Meera
Phone: +(91)-9246543890
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94. Shreeji Pharma International
Engaged in production and export of homeopathic medicines such as single triturations tablets, bio combination tablets, single triturations powders and homeopathic syrups. Also offer pharmaceutical bulk drugs, pharmaceutical API and camptothecine.
Address: FF-10, Narsinghdham Complex, Sangam Charrasta,
Phone: +(91)-(265)-3019110 Fax: +(91)-(265)-2465036
Website: http://www.indiamart.com/shreejipharma
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95. Sintex International Limited,
Address: Near Seven Garnala, Kalol (N. Gujarat), 382721
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96. Sree
Address: Chinchwad Industrial Area, Pune.
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97. Srivastava Homoeo Pharmacy,
Address: MIDCD- 2, No. 67-D, Pimpri, Ghonohwad, Pune
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98. State Cooperative Homoeopathic Pharmacy,
Address: Alapuzha, Kerala.
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99. Sudha Homoeo Pharmaceuticals,
Address: 10-22, Ram Nathpur,
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100. Sunder Homoeo Sadan,
Address: 113,
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101. Suresh Laboratory (Homoeopaths),
Address:
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102. Trans Pharmaceuticals,
Address: A-9, Co-op Industrial Estate P.B. No. 96, Jalgaon 425 003.
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103. Turab HV Herbals Private Limited
Manufacturer & exporters of homeopathic medicines.
Address: Corner Of Modi No. 3,
Phone: +(91)-(712)-521105 Fax: +(91)-(712)-537350
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104. United Globules,
Address: Dujana House, Matia Mahal,
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105. Upadhyay Homeo Research Lab Private Limited
Manufacturers of homeopathic medicines, biochemic medicines, cough syrup, dandruff oil, liver tonic, heart drops, triturations and tonsil tablets.
Address: 234, B Rambali Nager
Phone: +(91)-(98)-93019362
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106. US Export Private Limited
Manufacturer and exporter of homeopathic medicines.
Address: Plot No.-12, Kharkhana, Kaushalya Estate,
Phone: +(91)-(40)-7742343 Fax: +(91)-(40)-7742343
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107. Vinayak International,
Manufacturers and exporter of homeopathic, ayurvedic, herbal, unani medicines and herbal supplements.
Address:
Phone: +(91)-(591)-3299122 Fax: +(91)-(591)-2320327
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108. Dr. Wellmans Homoeopathic Laboratory Limited
Manufacturers of homoeopathic products including liquid patents, tablet patents, bio chemic compounds & single renedies, mother trincture & dillutions.
AM-2, Dilkhush Industrial Estate,
Phone: +(91)-(11)-27458874 Fax: +(91)-(11)-27232029
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109. Wheezal Laboratories,
157,
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110. Dr. Willmar Schwabe India Private Limited
WHO GMP APPROVED (June 2007) Manufacturers and exporters of homeopathic medicines.
A-36, Sector-60, Phase III, Noida - 201 304,
Phone: +(91)-(120)-2580903/2580904/2580905/2580109 Fax: +(91)-(120)-2580254
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111. Zahid Noorani
Manufacturers of homeopathic medicines for heart & other diseases.
Address: 177,
Phone: +(91)-9302533737
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LIST OF NON MANUFACTURING HOMEOPATHIC EXPORTERS – WEB SEARCH
1.Aagrawals Homeo Point
Exporting of homoeopathy medicine and naturopathic medicines.
Address: 330, GyanKhand 1, Indirapuram,
Phone: +(91)-(120)-2345762
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2. Appolo Homoeo Pharmacy
Exporters of all types of homoeopathic medicines.
Address: 87, Uphaar, Eldeco-I,
Phone: +(91)-(522)-2446043 Fax: +(91)-(522)-2332313
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3. Care N Cure Health Clinic
Exporters of very effective homoeopathic treatments for hairloss, alopecia, thinning of hairs, dandruff, grey hairs, overweight, skin blakish, white discoloration, pimples, warts, piles, constipation, acidity, impotency.
Phone: +(91)-(80)-25561088
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4. Dr. Roshanlal Aggarwal and Sons P. Ltd
Suppliers and exporters of homeopathic medicines, homeopathic biochemic tablets, homeopathy biocombination tablets, dilutions, mother tinctures, cineraria eyedrops, homeopathic medicine for diabetes, hair loss homeopathic medicine.
Address: 16- Netaji Subhash Marg, Daryaganj, New Delhi - 110 002, India
Phone: +(91)-(11)-23271372 Fax: +(91)-(11)-23282080
Website: http://www.indiamart.com/recekweg/
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5. Himalaya Herb Stores
Exporters of homeopathic medicines & herbs like alfalfa, carduus mar, hyoscymus niger, thalaspi, wild cherry bark, avena and many others.
Address: 1, Vinod Bhawan, Madhav Nagar, Saharanpur - 247 001, India
Phone: +(91)-(132)-2661695 Fax: +(91)-(132)-2661695
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6. Hompath
Exporters of homoeopathic medicines.
Address: 8, New Hariniwas, Dattatraya Road, Santacruz (W), Mumbai - 400 054, India
Phone: +(91)-(22)-6172032
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7. Ivy Comm Systems
Exporters of herbal medicines, ayurvedic products, diabetic supplies, herbal extracts.
Address: 1405, Sector-14, Faridabad - 121 007, India
Phone: +(91)-(98)-18181405 Fax: +(91)-(129)-4003781
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8. Tescon Trading Company
Exporters of homeopathic medicines.
Address: 57/2 N, N. S. C. Bose Road., Kolkata - 700 040, India
Phone: +(91)-(33)-24815555 Fax: +(91)-(33)-24818788
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9. Yogee Advance Homeo Herbal
Engaged in exporting of homeopathic medicines, herbal ayurvedic medicines, Indian ayurvedic medicines, diaberid medicines, herbal pellets, astherb syrup, astherb capsules, danfin oil and pain control medicine.
Address: 203, Juhi Plaza, Geeta Bhawan, Square, Indore - 452 001, India
Phone: +(91)-(731)-5068287
NEW RESEARCH FORM: HOMEOPATHIC LINE OF TREATMENT
Please take your time and fill out this form at length. This form is of crucial importance in researching the correct selection of homeopathic remedies/ line of treatment.
DATE
NAME
ADDRESS
CITY/ STATE/ PIN
PHONE
MOBILE
AGE
SEX
DATE OF BIRTH
PLACE OF BIRTH
PRESENT HEIGHT Ft & ins / cms
PRESENT WEIGHT Pounds/ Kg
MARITAL STATUS
CHILDREN
BUSINESS / WORK
DESCRIBE YOURSELF IN 50 TO 100 WORDS.
PRESENT COMPLAINTS. Please list each complaint and describe in detail (memory, vision, taste, smell, sleep, dreams, digestion, elimination, hair, skin, circulation, heart, lungs, organs, joints, muscles, glands, thyroid, bones, neck, spine etc)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
ONSET, ORIGIN OR CAUSE When did complaints begin? Were there any event (s) responsible eg injury, accident, dental work, operation, grief or shock?
PAST HISTORY (PREVIOUS DISEASES AND TREATMENT) List details about your past medical history, including dental work, operations and injuries.
SUPPLEMENTS/MEDICINES List dosage and frequency of all supplements/ medicines.( BP, diabetes, thyroid, anti depressants, steroids, hormones, vitamins, supplements etc )
FAMILY HISTORY Relatives (mention relationship) suffering/suffered from : ALLERGIES
Eczema ……..Y/ N
Skin allergy……YES / NO
Hay fever ……YES / NO
Sinusitis or colds ……YES / NO
Allergic bronchitis ……YES / NO
Asthma ……YES / NO
Urticaria ……YES / NO
ARTHRITIS
Gout ……YES / NO
Osteoarthritis ……YES / NO
Rheumatoid arthritis ……YES / NO
OTHER MEDICAL CONDITIONS
Cancer/Malignancy ……YES / NO
Diabetes Mellitus ……YES / NO
Hypertension ……YES / NO
Coronary Heart Disease. ……YES / NO
Tuberculosis (Pleurisy) ……YES / NO
Gonorrhea/Syphilis or STD ……YES / NO
Psychiatric A Mental Disorders ……YES / NO
Schizophrenia ……YES / NO
Anxiety Neurosis Depression ……YES / NO
Hyperthyroidism/Hypothyroidism ……YES / NO
Any other sickness not mentioned above.
PERSONAL HISTORY: Kindly elaborate and mention habits like drugs, smoking, tobacco, alcohol etc.
APPETITE :
Grade as per preference +1, +2, +3/ dislike or aversion -1, -2, -3
Sweets ……… What do you like?
Salt and salty food (any extra salt) …….
Sour things like pickles/ vinegar ………
Seasoned and spicy …………
Milk ………………..
Eggs …………
Fried foods and fat ………..
Foods that you like ……….
Foods that you dislike ……..
Complaints after eating.
Fullness of abdomen ……YES / NO
Gas formation ……YES / NO
Diarrhea ……YES / NO
Can you remain hungry for long periods? ……YES / NO
Do some foods cause any discomfort e.g. acidity. headache, flatulence etc. ……YES / NO
Details of foods/timings?
Do you feel bloated, full and heavy after eating ……YES / NO
THIRST:
State or grade +1, +2, +3 / -1, -2, -3
How much water do you take at one time?
How many times per day?
Would you prefer warm/ hot in the height of summer? +1 +2 +3 / -1 -2 -3
Would you prefer cold/chilled water/drinks in the height of winter? +1 +2 +3 / -1 -2 -3
Iced cold drinks/ water +1 +2 +3 / -1 -2 -3
Cold drinks +1 +2 +3 / -1 -2 -3
Warm drinks +1 +2 +3 / -1 -2 -3
Very hot drinks +1 +2 +3 / -1 -2 -3
GENERALITIES State how you are affected by or how you react to the following :
1. Cold in general: cold air, drafts, cold winds etc.
2. Warmth in general: warmth of bed or of room, external warmth etc.
3. Weather: dry, cold, wet weather, rains, cloudy etc.
4. Thunder storms?
5. Open fresh air?
6. Sunlight and exposure to the sun?
7. Near the sea? Near the mountains?
8. Eating and drinking (before, during or after) any symptoms?
9. Fasting?
10. Any particular item of food /drinks which adversely affect you (or make you sick) ?
11. Closed, crowded places (e.g.: elevators etc.)
12. Exertion or physical strain, mental strain ?
13. Lack of sleep ?
14. In what part of 24 hour day ...
Do you feel the best? Is there a specific time?
Do you feel the worst? Is there a specific time?
15. Do your troubles tend to occur or become worse periodically ? (e.g.; daily or
alternate days, every week, yearly, during new or full moon etc.)
STOOL/BOWEL MOVEMENTS
Do you regularly have a satisfactory bowel evacuations?
How many times do you move the bowels? When?
Consistency
Odor
Color of stool
Any straining for stools, even though they might not be hard or constipated?
Any urgency for stools (e.g. : do you have to run for bathroom first thing on waking up,
in the morning or immediately after eating)
Any pain, burning. bleeding with stools? Piles/Fissure/Fistula?
Do you have flatus (wind) along with stools and is it noisy?
URINE
Frequency, day and night; any smell (odor) in the urine?
Any difficulty in passage of urine?
Any difficulty in retaining urine?
Any associated complaints with urination?
SEXUAL SPHERE FOR MEN
Any sexual disturbance?
Excessive desire or aversion to sex?
Disability or performance, premature ejaculation etc.
Night emissions
Any H/O sexual abuse, excessive masturbation etc.?
Any problem or complaints after intercourse?
SEXUAL SPHERE