Pain Abdomen 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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Pain Abdomen Questionnaire

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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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Pain Abdomen 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 *

Do you have generalized abdominal discomfort or pain (pain that is difficult to pinpoint)?

Never / don't know
Occasional moderate discomfort
Frequent moderate discomfort
Occasional severe pain
Frequent severe pain

Do you have pain at the right side of your abdomen, between the bottom rib and the hip?

Never / don't know
Occasional moderate discomfort
Frequent moderate discomfort
Occasional severe pain
Frequent severe pain

Do you have pain at the left side of your abdomen, between the bottom rib and the hip?

Never / don't know
Occasional moderate discomfort
Frequent moderate discomfort
Occasional severe pain
Frequent severe pain

Do you have pain at the lower front of your abdomen?

Never / don't know
Occasional moderate discomfort
Frequent moderate discomfort
Occasional severe pain
Frequent severe pain

Do you have a dull, constant ache on either or both sides of your lower abdomen near the pelvis, but above the genital area?

Don't know
No
Left side only
Right side only
Both sides or in the middle

Are you currently experiencing severe pain in the lower abdomen?

Don't know
No
Yes, lower left side only
Yes, lower right side only
Yes, both sides and middle

If you are currently experiencing abdominal pain, for how long has this pain been present?

Not applicable / don't know
Less than one week
1-4 weeks
1-3 months
Over 3 months

When you have abdominal pain, does a bowel movement reduce it?

Not applicable / don't know
No
Moderate improvement
Big improvement - the pain disappears

Does a large or fatty meal cause upper abdominal pain, perhaps worse at night?

No / don't know
In the past only
Mildly / occasionally
Moderately / often
Seriously / always

Have you suffered from heartburn (burning at top of stomach) or gastric reflux?

Don't know
No
Past episode(s) now resolved
Current minor problem
Current major problem

Do you have a sense of lower abdominal fullness, NOT caused by abdominal gas?

Don't know
No
Somewhat
Definitely, but not all the time
Definitely, almost always

Are you experiencing any abdominal swelling or bloating?

Don't know
No
Yes, slightly noticeable
Yes, very noticeable
Add any additional information here for the questions above:

Have you noticed pressure or 'fullness' under your lower left rib cage, which is painless or slightly tender? Do not answer this question if there is definite pain in this area.

Don't know / there is definite pain
No
Yes, slight pressure
Yes, definite pressure

Do you have pain or discomfort in the upper abdominal (stomach) area, below the breastbone?

Don't know
No
Occasionally / mild
Several times a week / moderate
Frequently / severe

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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