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General Information
Name
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Age
Gender
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Weight (Kg)
Height (cm)
Blood pressure (mmHg)
Pulse (/min)
City
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Lifestyle (Tick all that apply)
Alcohol
Cigarettes
Deep sleep
Stress
Drugs
Constipation
Red meat
Sugar
Fried/grilled food
Trans-fat
Emotional eating
Air, odour or noise pollution
Hard/strenuous work
General symptoms
Feeling weak/fatigued
Loss of appetite
Bloating
Strong body odour
Rapid weight and height loss
Muscle aches
Sore eyes
Easily stressed
Frequent headaches or dizziness
Constipation or pale/blood/tar-like stool
Frequent urination or dark urine
Mood swings
Dry, wrinkly skin
Hair loss and/or grey hair
Getting frequent colds
Food allergies
Facial swelling or puffy face
Insomnia and other sleep disorders
Irritability and anxiety
Sensitivity to temperature changes
Night sweats
Severe menstrual cramps and heavy or irregular periods (women)
Enlarged prostate and painful groin (men)
Reduce sex drive
Low or no breast milk after giving birth(mothers)
For sick patients (Please provide medical reports if possible)
Diabetes / Cholesterol / Atherosclerosis / Blood pressure / Gout
Allergy / Sinus / Asthma, Autoimmune
Cancer / type... / stage...
Thyroid / Hormone / Prostate
Kidney
Liver
ALS / Muscle fatigue
Obesity
Corona virus (COVID19, SARS, MERS, Ebola/Influenza)
HIV / AIDS
Erectile Dysfunction (Men) / Frigidity or Female Sexual Dysfunction (Women)
