Skin Questionnaire - HomeopathicVibes

Call Us: (408)-737-7100
Our Address: 940 E El Camino Real, Sunnyvale, CA - 94087 | 39039 Paseo Padere Parkway,Suite #209,Fremont, CA 94538

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Skin 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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Conditions We Treat

Skin Conditions
Neurological Conditions
Stomach Conditions
Pulmonary Conditions
Alcoholism
Autoimmune Disease
Women’s Conditions

Skin 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 *

Since how may years you had skin problems?

1-5 years
10-15 years
6-10 years
more than 15 years

Have you tried alternative treatment before for this condition?

Yes
No

How long did you take treatment?

How serious you think your skin condition is?

Mild
Moderate
Severe

What part of your skin is most affected?

Head or neck
arms
legs
hands
Feet
buttocks
genitals
thighs
scalp

Do you feel worried about the condition of your skin?

Yes
No

Does anybody in the family have similar skin disorders?

Yes
No

Does anybody in the family have similar skin disorders?

Yes
No

Are you a

Vegetarian
Non vegetarian

Is there any fluid coming out of your skin?

Yes
No
Occasionally

Do your skin get worst by season?

Winter
Summer
Neither

Does your skin get worst by open air?

Yes
No
Neither

Does your skin gets worst by shower?

Yes
No
Neither

Does your skin get better by shower?

Better
worst
Neither

Are you suffering from any allergies?

Yes
No
Never
Sometimes

Do you sleep well?

Yes
No

Do you have constipation?

Yes
No

Are you suffering from diabetes?

Yes
No

Are you suffering from Hypertension?

Yes
No

What fabric your wear most often?

Cotton
Polyester
Synthetic

Do you take any alcoholic drinks?

Daily
Occasional
Never

Are you using cortisone or other local creams on it?

Yes
No
Never
Sometimes

What is your body type?

Cold or Chilly
Normal
Hot or warm

Email

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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Weekdays: 10:00 am - 6.00 pm
Weekend: By Appointment only

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