Vedic Panchakarma & Pregnancy

Old RTO Chauraha, Sarnath, Varanasi

Contact: 9682222121 | 7678887878

Consultation Fee: ₹
Payment Mode: Receipt No:

1. Patient Information

Full Name:
DOB:
Age:
Gender:
Marital Status:
Occupation:
Contact:
Other:
Address:

2. Vital Signs

BPPulseSpO₂ WtHtBMI GirthRBS

3. Chief Complaint

4. Past Medical History

5. Family History

6. Lifestyle & Mental Health

Sleep Hours:
Addiction:
Anxiety:
Depression:

7. Female-Specific History

Menarche:
Cycle:
LMP:
Pregnancies:
Abortions:
Delivery:

8. PCE Notes