What can I do for you?

Current complaints

Which parts of the body are affected? headneckchestheartstomachbackspinearmshoulderelbowhandleghipkneefootMiscellaneous

What complaints do you have?

How long have the symptoms existed?

How did the symptoms develop? lessconstantstronger

How severe are your symptoms? 0-none123456789-maximum

Have the symptoms appeared before? yesno

-- how often have they appeared?

-- how long did they last?

Has therapy ever been attempted?

previous illnesses

Heart: e.g. constriction of the coronary arteries, heart attack, cardiac arrhythmia

Circulatory system: e.g. blood pressure: too high, too low; fainting

Vessels: e.g. circulatory disorders, varicose veins, thrombosis

Metabolism: e.g. diabetes, gout, elevated blood lipid levels, thyroid disease

Skin: e.g. neurodermatitis, psoriasis

Lung: e.g. chronic bronchitis, asthma

Stomach/intestines: e.g. heartburn, stomach ulcers, intestinal inflammation

Liver, gallbladder: e.g. liver enlargement, jaundice, gallstones, colic

Kidney/urinary bladder: e.g. kidney stones, colic, frequent bladder infections

Skeletal system: e.g. rheumatism, osteoporosis, broken bones, injuries

Nervous system: stroke, abnormal sensations, tremors, multiple sclerosis

Psyche: e.g. depression

CancerOther:

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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