Patient Guidelines Sheets

Find Below the online copies of Patient Guidelines Sheet. Patients are requested to promptly collect the Patient Guideline Sheet after every consultation which will have the guidelines and medical advice suggested to the patient.

PATIENT GUIDELINES SHEET

Name of the Patient:

Age/Sex/Marital Status of the Patient:

Religion/Nationality of the Patient:

Name of the Guardian of the Patient:

Residential Address:

Contact Phone number of the Patient:

E-mail id of the Patient:

Condition/Diagnosis for which Consultation was provided:

Treatment method Selected:

[ ] Homoeopathy     [ ] Counseling     [ ] Nutrition     [ ] Clinical Hypnosis

[ ] Hypnotherapy     [ ] Exercise Therapy     [ ] Golden Ray Reiki

Treatment Plan:

General Feedback/Suggestions about the consultation session and guidelines for the Patient:
Medication:
Nutritional Advice:
Lifestyle Advice:
Work – Rest Advice:
Exercise Advised:
Other Guidelines:

Next Appointment Scheduled:

Date:
Signature
Place:

Be Healthier and Happier. Become Empowered and Enriched.

Dr Maharaja SivaSubramanian N

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Dr Maharaja SivaSubramanian N is India’s 1st Holistic Concierge Medicine Doctor specializing in Homoeopathy, Counselling, Hypnotherapy, Nutrition, Exercise Therapy. Contact Dr Maharaja N for your treatment needs.