Fallopian 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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Fallopian 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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Fallopian 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

Marital status:

Married
Single
Divorced
Widow

Did you ever have pelvic exam by your Gynecologist?

Yes
No

If yes when

What was Gynecologist‘s findings

Did any procedure of surgery was ordered that time?

Yes
No

If yes when and what

Have you ever been pregnant before?

Yes
No

Number of live births:

Number of vaginal deliveries:

Number of miscarriages/still births:

How long you been trying to get pregnant?

Yes
No

What day of your cycle do you usually ovulate?

Did you ever have had pain in pelvic area?

Yes
No

If yes please describe

Did you ever have pain in abdominal area?

Yes
No

If yes please describe

Did you ever felt sensation of pressure in pelvis?

Yes
No

Did you ever have any abnormal vaginal discharge?

Yes
No

If yes please describe

Did you ever have any abnormal vaginal bleeding?

Yes
No

If yes please describe

Did you ever felt any pelvic mass?

Yes
No

If yes please describe

Have you had any other pelvic tests/procedures relating to your diagnosis, i.e., ultrasound, pelvic laparoscopy, D&C, tubal ligation?

Yes
No

PROCEDURE/EXAM

RESULTS

Name

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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