Therapeutic service form

Therapeutic service form

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Name
These problems are?
Do you suffer from:
Do you have bowel movements daily?
The stool is usually:
What type of weather do you feel most uncomfortable in?
Your skin has a predominant tendency:
Your diet is:
What is your main meal (the one with the largest volume of food)?
Your digestion is:

Briefly describe your typical daily meals:

Which flavor do you like most?
Do you often eat:
Do you practice physical exercise?
How often?
What type of exercise?
Do you have a tendency to:
Do you smoke?
Do you drink alcoholic beverages
What is your mental state like?
Are you under any medical care
Have you had any side effects with the treatments received?
How is your sleep?
Do you sleep during the day?
Have you been feeling some kind of fear for no apparent reason?
How is your sweating?
Your menstruation is:
Your menstrual flow is:
Do you have any type of discharge outside of your menstrual period?
Symptoms associated with menstruation: