7/21/2019 Treatment Sheet Aradhan.pdf

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Shri / Smt. / Kum: Age:....................................................................................................... ................

Mobile No:Sex:Date of Birth: ................................ ................... ......................................................Address:....................................................................................................................................................

.................................................................................................................................................................

Date:...........................No: ...........................

Heart Problem:.......................................................... Height:.......................... Weight:..........................

Yes NoBP: High BP :........................... Low BP:..................................

Diabetes: Yes No FBS:........................... PBS:........................... Yes NoThyroid:

TREATMENT SHEET

Date TreatmentNo: ...........................

1 1

11

2 2

22

3 3

33

4 4

44

5 5

55

6 6

66

7 7

77

8 8

88

Hunger: Normal / Excessive / Deficient

Normal / Excessive / Deficient

Sleep: From................. To.................

Disturbed / Sound / With Dreams

Thirst:

Stools: Normal / Constipated / Hard / Loose

Urine: Day __________ Times __________

Normal / Burning / Trickling / Painful

Taste: Sour / Sweet / Salty / Spicy / Bitter

Emotional: Happiness / Anger / Tense / Fear / Sad

Periods: Timely _____ Days

Painful:Before / During / After

Clots / Scanty / Excess / Normal

Favorite Colour:VIBGYOR

Brown / Pink / Black / White

=

Evaluation of Teeth:

Lt Lower

Rt Upper Lt Upper

Rt Lower

Past History / Pathology Reports.

Alternative Medicine Study & Research Foundation

ARADHANUltimate Solution Point.........

7/21/2019 Treatment Sheet Aradhan.pdf

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Disease & Symptoms:

Date Treatment

Follow Up Treatment: