Purnagram. The Holistic Health Village

Online Doctor

A person who intends to consult Purnagram doctors by web will have to fill in the given proforma and submit. The given data will be analysed by the expert physicians of Purnagram and the end result/ suggestions for medicines, treatments, dietary and lifestyle changes required etc will be mailed back to the applicant in a week's time. Further, if he wants any help in procuring medicines or if he wishes to undergo the treatment course recommended by doctors assistance can be arranged by Purnagram.

Personal Details

Name
Address
House Number/Name
Street/Road
City/State
Country
Pincode
Telephone no
Email:
Age with Date of birth
Sex	Male Female
Marital Status	Married Unmarried
Number of Children, if any.
Nationality
Profession
Nature of work / occupation

Personal Data

Height	(in cms)
Weight	(in kg)
Habits if any	Alcohol
	Tobacco
	Others
Food Habit	Veg	Non veg
Sleep pattern	6 hrs
	8 hrs
	10 hrs
	Others
Appetite	good
	poor
	changing
Bowel movements	Constipated
	regular
	irregular
Likes of food	hot
	cold
	spicy
	sweet
	sour
Likes of climate	summer
	winter
	moderate
	tropical
Skin type	oily
	rough
	smooth
Allergies if any

Disease details:

Symptoms presented
Duration of present illness
Details of any Laboratory investigations done
Result of Scan/MRI / special investigations performed
Any cause inferred by you for the illness
Any treatments/ medications taken or continuing for present illness
Improvements after taking medications
Any serious previous illness
Surgery or any long term medications taken
Any chronic ailments suffered and medications continuing like Diabetes, High blood pressure, TB or Cardiac problems
Family history of any serious/ Chronic diseases
Allergies if any
Blood pressure if taken recently
Any other relevant information