Abdominal Follow up Questionnaire - HomeopathicVibes

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Our Address: 940 E El Camino Real, Sunnyvale, CA - 94087 | 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538

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Abdominal Follow up Questionnaire

Why Me?

I'm providing homeopathic services for over 20 years in entire California. My clinic is located in Sunnyvale, Fremont, and San Jose. I have treated more than 1000 patients suffering from various conditions. I also provide online consultation if you're not able to visit any of my clinics. I have more than 100 five stars reviews on Google, Yelp, and other reviews websites. If you would like to know more about me, then feel free to reach me out by phone.

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Skin Conditions
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Abdominal Follow up Questionnaire

940 E. El Camino Real
Sunnyvale, CA 94087
harminder@homeopathicvibes.com
www.homeopathicvibes.com
Office Phone (408)737-7100
Office Fax (408)737-7102

Name *

First

Last

Email *

How often you are taking the remedy? How many pills a day? How many drops from the bottle.

Did any of your existing symptoms improve since your appointment with us? If so, which ones?

Have you had any flare ups or new symptoms since your last visit?

Yes
No

Did any of your symptoms worsen? Which ones and to what degree?

Yes
No

Did any new events (stress, physical or emotional events) happen between your last visit and now that have affected you?

Yes
No

How may bowel movements you are experiencing in a day since your last visit?

Less than 4
4-6
7-10
More than 10

Do you still have urgency to run for passing stool?

Yes
No
Never

Have you been experiencing any abdominal pain or cramps since your last visit?

Yes
No
Never

Have you noticed any blood in your stools since last visit?

Yes
No

Have you noticed any pus or mucous in your stools since last visit?

Yes
No

Since your last visit which area of your life has been negatively affected by your symptoms?

Nothing
Caused me to miss work or school
Caused me to miss or decline social activities
Made me anxious or depressed.

How would you rate you health level today and last visit? Number One being poor and ten being prefect health?

Today
Last visit

Anything else you want to communicate? Please use this question to add any other detail that you wantto communicate to me.

Comment

About Me

I have passion for homeopathy. I am blessed to be born in family of Homeopaths. My grand father Dr. Hazara Singh Gill was great homeopath of his times. He did his M.B.H (Bachelor of Medicine in Homeopathy) from Punjab Homeopathic Medical College Lahore in 1925.

Sunnyvale Location

Phone: 408-737-7100
Fax: 408-737-7102
Address: 940 E El Camino Real, Sunnyvale, CA 94087, United States
harminder@homeopathicvibes.com

Fremont Location

Phone: 408-737-7100
Fax: 408-737-7102
Address: 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538, USA.
harminder@homeopathicvibes.com

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Weekend: By Appointment only

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