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Arqiyat (21)
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1. Describe your main problems for which you want to seek our advice. *
2. For how long, are you suffering from these problems? *
3. How is your physique? *
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5. Do you have constipation? *
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7. Are you addicted to any other intoxicant (e.g., liquor/wine etc.)? *
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9. Do you suffer from sleeplessness? *
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11. Do you feel any irritation or burning sensation while passing urine? *
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12. Do you feel palpitation of heart or pain in chest or breathlessness during physical exercise? *
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15. Have you suffered from any disease earlier? *
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(a) ------If yes, name it.
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