Consultation Fee: PKR 2,000

Start Your Healing Journey Today

How It Works – 5 Simple Steps

1
Fill the detailed online case form below
2
Send your previous reports on WhatsApp
3
Pay PKR 2,000 via EasyPaisa / JazzCash
4
Receive personalized prescription within 24 hours
5
Free follow-up consultation after 7 days
Secure Payment Options

Choose your preferred payment method. All transactions are secure and encrypted.

🇵🇰 Local Payments (Pakistan)
EasyPaisa / JazzCash: 0300-1234567
🌍 International Payments
Credit / Debit Card • PayPal

Consultation Fee: PKR 2,000 (or equivalent in your currency). Please share payment confirmation on WhatsApp to book your appointment.

Patient Intake Form

1) Patient Identification

Basic details needed to identify and contact the patient.

Full Name *
Age *
Gender *
Marital Status
Occupation
City / Location *
WhatsApp Number *
Email Address
Date of consultation
Chief complaint in your own words *
This is the most important field. Write as freely as possible.

2) Mental and Emotional State

Mental and emotional symptoms often guide the highest grade rubrics.

How would you describe your personality?
Are you introvert, extrovert, or mixed?
What bothers or worries you most in life?
Emotional tendencies (select all that apply)
How do you react to stress?
Do you keep things inside or express them?
Was there any major emotional shock or grief before the illness started? If yes, describe.
Memory
Any difficulty concentrating?
Any fixed ideas, obsessions, or repeated thoughts?

3) General Symptoms

General symptoms apply to the whole body and are critical for analysis.

Thermal State
Perspiration: Do you sweat easily?
Where do you sweat most?
Does your sweat have any odor or staining?
Thirst
Appetite
Food desires (select all strong cravings)
Food aversions (select all strong dislikes)
Sleep position: How do you prefer to sleep?
Sleep trouble: when?
Energy pattern: When do you feel best?
When do you feel worst?
Describe any recurring dreams
e.g., falling, dead people, water, animals, fear-based dreams

6) Chief Complaint Details

Describe each complaint separately. Add more if needed.

Complaint #1
Location of complaint: Where exactly in the body?
Sensation: What does it feel like?
What makes the complaint WORSE?
What makes the complaint BETTER?
How did it start?
How often does it occur?
What triggered it?
Duration of this complaint

7) Concomitant Symptoms

Other symptoms that appear together with the main complaint.

Is there any other symptom that always appears together with your main complaint?
Example: headache with nausea, cough with urinary leakage, fever with thirstlessness.

8) Past Medical History

Any childhood illnesses?
Any skin eruptions or skin diseases in the past?
Were any skin rashes suppressed with ointments or steroids?
Have you used steroids/cortisone for any long period?
Any adverse reaction to vaccinations in the past?
Any major surgeries?
Any chronic diseases previously diagnosed?

9) Family History

Close family (parents, siblings, grandparents).

Diabetes
Tick all that apply

10) Current Medications and Treatments

Are you currently taking any allopathic medicines?
If yes, list them
Any previous homeopathic treatment?
If yes, what medicines were given and did they help?
Any supplements or herbal medicines?

11) Personal Habits

Smoking
Tea or coffee consumption
Alcohol consumption
Physical activity level

12) File Uploads

For now, we only capture file names/types/sizes and print them on submit.

Upload any blood test reports
Upload any ultrasound or scan reports
Upload any previous prescriptions
Upload photo of affected area if skin complaint

13) Patient Expectation

What result are you expecting from this treatment?
How long have you been suffering?
How did you hear about this clinic?
For MVP: this only prints the data (console + on-screen). No backend saving yet.
Or just message us on WhatsApp →
WhatsApp