Ayurveda - treating Parkinsons disease the natural way

If you always think, what you always thought,
you will always be, what you've always being -Think fresh, think Ayurveda.

Patient Registration Form

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*Name:

*Address:

*Age:

*Sex: *Occupation:

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Fax:

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Symptoms:

Tremors

Slow Movement:

Rigidity Stiffness:

Micrographia:

Speech Difficulty:

Reduced swings:

Gait Problem:

Short stepped:

Shuffling Leg:

Difficulty in
Getting Up:

Joint Pain:

Postural Instability:

Blinking Eyes:

Dryness:

Itching:

Hard to
Swallow Food:

Sleep Disorders

Difficulty in Sleep:

Pain during Sleep:

Nightime
Urination:

Nightmares:

Rapid or
Pounding Heart:

Dryness of Skin:

Problems with Memory

Confusion:

Mood Changes:

Depression:

Sadness:

Nausea:

Heartburn:

Loss of Appetite

Constipation:

Dry Mouth:

Sexual Dysfunction:

History including medical and surgical:

Present Complaints:

Symptoms, Duration and Previous Diagnosis:

Alcohol:

Smoking:

Tobacco:

Drugs:

Other Habits:

Non Vegeterian:

Vegeterian:

Family History and Other Investigations:

Diabetes, Hypertension - CNS findings in brief (Muscle Tone, Power, Reflexes, Involuntary Movement):

Difficulty in achieving and maintaining an erection?

Prostate:

Thyroid:

Fatigue:

Weight loss:

Current Medications:

Comments:

Also Download UNIFIED PARKINSON'S DISEASE RATING SCALE form and send it us by email.