Prostate 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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Prostate 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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Prostate 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 *

When you want to pass urine, is there a delay before you start?

Never
Sometimes
Usually

When you pass urine, do you find your flow stops and starts?

Never
Sometimes
Usually

When you think you have finished passing urine, do you find a bit more trickles out, and sometimes stains your underwear?

Never
Sometimes
Usually

Has your stream become weaker or thinner in the past year?

Not really
Yes, a bit
Yes, a lot

Do you feel your bladder is not quite empty after you have been to pass urine?

Never
Sometimes
Usually

How many times do you usually get up in the night to pass urine?

Never
1 - 3
4 or more

How many times do you go to pass urine in the daytime?

Less than 4
5 - 7
More than 7

Do you ever pass urine when you don't mean to?

Never
Sometimes
Often

Do you ever leaked urine and felt embarrassed?

Never
Sometimes
Often

Do you ever get hardness of organ in the morning without the urge of sex?

Never
Sometimes
Most of the time

Have you noticed decline in your sex drive in the past?

All of sudden
Slowly diminishing
No change

Do you feel lack of interest in sex from the past few years?

No change
Yes sometimes
Always felt like since few years

Do you ever get your PSA test in past years?

Yes
No

If yes (number was ….)

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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