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Information about your illness

What is your diagnoses from a doctor?

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Medical History

Physical Generals – Preferred Weather?

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Favorite Foods

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Urine

Perspiration

Sleep Position/Pattern

Speed (Walking, Eating and Working)

Sensitivity (Noise, Light, Traveling, Perfume, Dust etc.)

Females: Gynae and Obs history

Females: Menstrual history

Females: Age of menopause

Females: History of abortions or miscarriage

Family history: Name the diseases which your father/ mother/ siblings might have suffered

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Cigarettes per day

Alcohol drinks per week

Exercise per week

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