Note: Medicines cannot be couriered or posted to Gulf countries & UAE countries.
PATIENT
The complete process of registration is necessary for every person seeking consultation & treatment.
Basic information as mentioned in various blocks should be filled completely & sent through email. The Patient is required to send us his complete basic information like Name, Age, Sex, Date of birth, Permanent Address, and Contact details. Complete postal address with postal code is to be given.
Note: Incomplete address information may lead to delay or non-delivery of medicines.
A brief write-up is to be mailed regarding your complaint for which you wish to take consultation and treatment. Once the email is sent to us we will respond to you within 24 hrs & go through the payment procedure further procedure will be done accordingly. If willing one can make a payment right away or wait for our reply.
PAYMENT GUIDANCE AND REGISTRATION:
Once we confirm receipt of your mail and send you the reply, the patient is required to register himself/ herself by filling out the registration form with all mandatory details and make payment through Net banking or NEFT transfer or by depositing cash/ cheque in the nearest branch of HDFC Bank.
Our Bank details are as below:
- Account Name: Cosmic Homeo Healing Centre
- Account Number: 050200012113144
- Bank Name & Branch: HDFC Bank, Raopura branch, Vadodara.
- IFSC Code: HDFC0000429
- MICR Code: 39024000801802529
Inform us about the details of the payment done by you through Email and we will revert back to you immediately.
HISTORY FORM:
MEDICAL HISTORY FOR HOMEOPATHIC TREATMENT
DIRECTIONS FOR A WRITTEN SUBMISSION
Homeopathic & Holistic consultation requires all relevant information with regard to:
- The patient or person as a whole with individual attributes(mental & physical)
- Complaints-main as well as a subsidiary.
- All information given to us is, of course, strictly confidential.
*It is not compulsory to send us the complete write-up as per the history form but you may go through the entire form so as to be aware & prepared at the time of the phone, skype, or email consultation.
PRELIMINARY INFORMATION
Please supply the following information as standard routine:
- Name in full; Date of birth; Sex; Status: Single/ Married/Divorced/Widowed since
- Religion/Community/Sect.
- Vegetarian/Non-Vegetarian/Eggs.
- Addictions: Tobacco/smoking/tea/coffee/beer/whiskey & liquors(please state the quantity consumed).
- Educational career & Qualifications
- Occupation: Current & previous with a description of responsibilities & job satisfaction.
- Description of current family set-up: Full details pertaining to all the members, their ages, location, work they are doing & your relationship & responsibilities for them. Include in your list those who have died, stating the age at death, time/date of death & the cause for the same.
- Your daily routine from getting up in the morning to retiring at night. Include in this your dietary schedule furnishing full details in respect of the quantities consumed.
- Financial responsibilities & strains (present as well as in past)
- Difficulties experienced: At the place of work/family set-up/Social-give a full account.
CHIEF COMPLAINT
Describe fully what bothers you most. Each trouble should be detailed as under:
Full description of the trouble right from the time of onset, its subsequent development & spread & response to treatments taken. This should give a full idea of:
- The area affected: location, extension, the direction of spread, the march of events.
- The sensation experienced in the area of trouble.
- Conditions that have brought on the trouble: examine the circumstance that was present just before the onset or at the time of onset, paying attention to physical as well as emotional factors.
- Conditions that increase the trouble or those which afford relief.
- Other troubles experienced at the same time along with the main trouble: for example-perspiration/nausea/vomiting/gas etc.
OTHER COMPLAINTS
Describe here all other troubles you might be having or have had in the past. Each should be described fully as suggested above for the Chief complaints.
PERSONAL DATA
Give a full account of the following:
- Physical description of self
- Emotional nature & intellectual attainments & aspirations. Indicate to what extent you have been able to realize them. Give a clear picture of your relationships with family members, friends & associations & also a full idea of your responsibilities & what you feel about them.
- Reactions to surroundings-
A) Food: desires & aversions, foods that do not suit, etc.
B) General environment: weather, temperature, bath, recreation, addictions, etc.
C) Sleep & dreams
D) Sex (inclusive of menstrual & obstetric history)
PREVIOUS ILLNESSES
Give a detailed description of the various illnesses you have experienced & had in past & to what extent they have a bearing on present troubles. Also detailed information about any surgeries performed on you in the past.
FAMILY HISTORY
Data concerning your parents, siblings & if possible also Grandparents. State details concerning the health of wife/husband & children.
GENERAL COMMENTS
Include here anything which you have not mentioned above or would like to share with us.
ENCLOSURES
- Medical reports & opinions on your state of health from your physician.
- Copies of reports & investigations done.
- X-ray plates, Electrocardiograms, etc.
INTERVIEW AND CONSULTATION:
Once your history form is with us we will respond to you in 2-3 working days & inform you about a time and date for consultation which may be either through phone or skype.
RECEIVING MEDICINES:
Once the consultation is done, your medicines will be dispatched within 1-2 working days. For overseas patients at least 10-15 working days are required to get the medicines and for residents of India the medicines will be delivered within 3-4 working days. [Please inform us through Email once you have received the medicines.]
Overseas patients will be sent medicines for 90 days (3 months) and patients in India will be sent medicines for 30 days (1 month).
FOLLOW-UPS AND REFILLS:
For overseas patients, the follow-up is to be given first through Email after 45 days of starting the medicines. If needed we will give you a prior appointment for a telephone or skype consultation with a time and date. Once the follow-up is done you need to pay for the next set of medicines & inform us about the payment details & we will send the medicines accordingly. Charges only for medicines and postage/ Courier are to be deposited in the bank.
For patients residing in India, follow-up is to be given after 20 days of starting the medicines via Email and we will give you the exact date and time for phone or Web/ Skype consultation accordingly. After consultation, the next set of medicines will be sent once the payment for the medicines and Courier / Postal Charges are deposited in the bank.