What can I do for you?



    Current complaints



    Which parts of the body are affected?



    What complaints do you have?

    How long have the symptoms existed?

    How did the symptoms develop?

    How severe are your symptoms?



    Have the symptoms appeared before?

    -- how often have they appeared?

    -- how long did they last?



    Has therapy ever been attempted?



    previous illnesses



    Have you already had an operation? (what, when)

    Have you ever had a serious accident? (which, when)



    General information



    Are you currently taking any medication? (which, in which dosage)

    What is your profession?

    Is there currently a particularly stressful situation at work, family or otherwise?

    What about the use of stimulants such as alcohol, nicotine or other drugs? (which, in which dosage)



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