Ask Expert

Anyone can request an appointment with Aura Homeopathy. Please complete the form below keeping in mind that the more information you give us, the better we can handle your appointment request.

Name of the Patient *
Age * (Yrs.)
Sex *
Weight (Kg)
Height (e.g. 5 feet, 7 inches)
Marital Status
Email *
Mobile *
Complete Postal Address
Country *
1. Describe your main problems for which you want to seek our advice. *
2. For how long, are you suffering from these problems ?
3. How is your physique ?
4. How is your appetite ?
5. Do you have constipation ?
6. Type of food that you eat.
7. Do you consume tobacco in any form ?
8. Are you addicted to any other intoxicant
(e.g., liquor/wine etc.) ?
9. Do you take excessive quantity of tea
or coffee ?
10. Do you suffer from sleeplessness ?
11. Do you suffer from excessive urination ?
12. Do you feel any irritation or burning sensation while passing urine ?
13. Do you feel palpitation of heart or pain in
chest or breathlessness during physical
exercise ?
14. Are you a patient of High Blood Pressure ?*
15, If yes, mention your blood pressure. Systolic / Diastolic
16. Are you suffering from Diabetes ?*
17. If yes, mention Blood Sugar

18. Have you suffered from any disease earlier ?
19. If yes, Name it.
20. If you have recently undergone a medical check-up pertaining to blood, urine, stool, sputum, any x-ray / ultrasonography, please mention the related reports.
21. Any other problem that you might like to state.
22. Is there a history of any hereditary disease in the family ? Systolic / Diastolic
23. If yes, mention it.
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