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FB Homoeo - Fine & the Best
FB Homoeo - Fine & the Best
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Patient Form
Ref. Nr.:
Patient Name:*
Email:*
Address:*
Wds Of
S/o:
D/o:
W/o:
W/S/D of
Contact Nr.:
Age in years (Only Number):
Sex:
Male
Female
Height(cm):
Weight(Kg):
Symptoms(Mental, Physical, Gener, Likes/Dislikes, Agravationss, Ameliorations):
Allergies:
Signs:
Any diagonosis and testresults:
Remedies used in past:
Instructions:
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