Tell About your Disease

TELL ABOUT YOUR HEALTH ISSUES

Its a questionnaire used to measure an individual's overall subjective and objective health status. Please take few minutes to answer the question.

Name*

Age*

Gender*

Phone:*

Email:*

Write Down Your Detail Health Problems:*

You have been suffering since?*

Are you under any treatment?*

What the treatments you are taking now? *

Since how many days or months you have been taking this treatment? *

What is the percentage of improvement after the treatment? *

Are you fully satisfied with the present treatment? *

Are you worried about any drug side effects of your present treatment? *

Have your doctor explained you in detail about your health problems? *

What is your opinion regarding the cost factor of the present treatment? *

Do you want any treatment which is safe, free from drug side effects, effective and cure the disease not suppress? *

Do you want a treatment that not only improve your health issue but also improve your health as a whole? *

Have you ever tried any alternative system of therapy? *

If yes which one: *

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