Riches of Health Logo ברוך אתה ה' אלהינו, מלך העולם Yahshua

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DISTANT CONSULTATION



Full Names:
Date of Birth:
Blood group:
Religion/belief system:
Height:
Weight:
Profession:
Marital status:
Children:
Diagnosis:
Main complaints:
Medical reports:
Blood results:
Photos of the eyes, ears, face, tongue, teeth, hands, feet, full body front, side and back:
Flossing frequency:
Number of amalgams:
Number of root canals:
Poisonings:
Allergies:
Operations:
Blood transfusions:
Head injuries:
Body injuries:
Vision:
Hearing:
Smoking:
Drinking:
Coffee:
Ordinary tea:
Cold drinks:
Chewing gums:
Diet: carbohydrate, protein or mixed?
Number of meals per day:
Microwave oven use:
Margarine/canola oil consumption:
Mothballs/naphthalene presence at home:
Hormonal contraception (women only):
Glasses of water per day:
BP:
Resting heart rate per minute:
Hours and type of exercise per day:
Hours of sleep:
Hobby:
Fasting glucose:
Fasting cholesterol:
Full blood count:
Uric acid:
Lipoprotein (a):
Homocysteine :
Thyroid function and antibodies:
Kidney function:
Liver function:
D-dimer:
Medication:
Supplements:
Email:
Phone No:
Booking Date:
Booking Time:

Comments: