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Treatments Of Piles
How To Use The Device
Types Of Piles
Piles Cure Treatment without Surgery
Bleeding-Piles-Treatment
About
FAQs
Testimonials
Clinic Locator
Media
Contact Us
Buy Now
Treatments Of Piles
How To Use The Device
Types Of Piles
Piles Cure Treatment without Surgery
Bleeding-Piles-Treatment
About
FAQs
Testimonials
Clinic Locator
Media
Contact Us
Buy Now
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Phone
City
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Basic Information
BRIEF CLINICAL HISTORY
OTHER MEDICAL HISTORY
BOWEL HISTORY
ARE YOU SUFFERING FROM
Basic Information
Name
Age
Mobile No.
Email
Address
City
State
Country
Date Of Appointment
BRIEF CLINICAL HISTORY
BLEEDING PER RECTUM/ PUS FORMATION
Yes
No
PAIN IN OR AROUND THE ANUS
Yes
No
CAN YOU FEEL A HARD PAINFUL MASS AROUND THE ANUS?
Yes
No
DO YOU FIND IT DIFFICULT TO SIT?
Yes
No
PROTRUDING MASS BEING FELT AT THE ANAL OPENING DURING OR AFTER DEFECATION
Yes
No
OTHER MEDICAL HISTORY
ARE YOU TAKING ASPIRIN
Yes
No
ARE YOU TAKING ANY OTHER ORAL MEDICINE/LAXATIVE?
Yes
No
HAVE YOU UNDERGONE ANY PREVIOUS SURGERY FOR PILES?
Yes
No
DIETARY PATTERN
Veg
Non-Veg
Addiction (IF ANY)
Allergy (IF ANY)
HOW LONG HAVE YOU BEEN SUFFERING FROM PILES?
BOWEL HISTORY
CONSTIPATION :
Yes
No
HARD STOOL
Yes
No
PERSISTENT FEELING OF STOOL LEFT IN THE ANAL CANAL AFTER BOWEL MOVEMENT
Yes
No
LOOSE MOTION
Yes
No
MUCUS WITH STOOL
Yes
No
ITCHING IN OR AROUND THE ANAL CANAL
Yes
No
BURNING SENSATION
Yes
No
DISCHARGE
Yes
No
ARE YOU SUFFERING FROM
DIABETES
Yes
No
HYPERTENSION
Yes
No
HYPOTENSION
Yes
No
LIVER DISORDERS
Yes
No
DYSENTERY
Yes
No
OTHERS
SHOW SUMMARY
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