Consultation

Welcome to PPSC!

We are providing free E-mail consultation. Please go through the procedure given below:
   1.   Fill up the history form carefully given below and submit it. Please attach report copies with it (Blood reports, X-ray, MRI etc.) which can be useful for diagnosis.
   2.   After detailed analysis of your health details, our doctor will contact you by e-mail asking for further health information, if necessary.
   3.   Then doctor will give you suggestions about possible treatment plan, diet changes and life style changes. (If you want to order medicines for your problem, you have to pay according to the cost of the medicines.)

Fill the history form carefully given below and submit. So we can understand much more about you and your pain.
We will answer you shortly after complete analysis of your problem.

Name :

Age :

Occupation

Sex :
Male Female Other

Marital Status :
Married Unmarried

Email ID :

Contact No. :

Address :

Presenting Symptoms

Mention your symptoms as detailed as possible. Mention about Site of pain / Stiffness / Swelling / Tenderness with duration.

Nature of Pain : Onset : Sudden Gradual

Pattern : Continuous Intermittent

Pain at rest : Yes No

Aggravating Factor : During wake up at Morning Afternoon Evening Night Winter Summer Monsoon

Radiation of pain :

If intermittent, Interval time of pain (once in a day, twice in a week etc.)

When pain begins, till which duration it continuous?

Pain increases with : Sitting without support Walking Sleeping Kneeling Sitting with support also Working Bending Coughing Sitting to Standing Running Squatting Driving Sitting with crossed Legged Exercise Lifting Any type of Movement

Pain decreases with : Rest Fomentation Walking Medicine Ice Pack Forward Bending Oil Massage Exercise Backward Bending

Effects of pain : Decreased Functions Quality Of Life

Physical activity resstricted : Household Work Going for Work Sitting Walking Social Function Daily Routine

Last Date that patient Worked :

Support for Walking :
Stick Walker Wheelchair

Pain Score (Give score from between 1 to 10 as per given below picture) :

Appetite : Increased Decreased Normal Altering Nature

Stool :
Hard Semi Solid Waterly Dry Sticky Constipation

Frequency

Urine :
Normal Burning Sensation

Frequency

Sleep :

If u feel Abdominal heaviness / Bloating (Gas) / Lethargy / Morning Stiffness :

Emotions : Anger Stress Depression Crying Sucidal attempt Fear Irritable

Previous Treatment taken for Pain : Allopathic Medicine Surgery Radio Therapy Intra-articular/ Epidural Injection Chemotherapy Physiotherapy Ayurved Homeopathy/Others Current therapy/Drugs

Response of Previous treatment

Medical History :

Do you have any associated diseases like Hypertension / Diabetes / Thyroid / Obesity etc.? What treatment are you taking for it? Mention with duration.

Mention Your Blood Pressure Level :

Investigation :

Laboratory Investigation : Give details with the date of the report :

Radiological Investigation like X-ray, MRI, USG etc. :
Give details with the date of the report :

Attach all reports copy here :

Diagnosis (As told by your previous physician)

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0002421

9-10,1st Floor, New Bus-Port, Becharpura Rd,
Nr. Rokadiya Hanuman Mandir,
Palanpur, Gujarat 385001

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+91 9426910461
+91 7069416768