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DAFFODILS POLY CLINIC Sector 14, Udaipur, Rajasthan 313001

APPOINTMENT: +9194141 56701

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Contact Us

Our Treatments

Piles

Migraine

Sciatica & Cervical Spondylosis

Female Diseases

Hair Fall

Pimples

Dental care

Piles

1.WHAT ARE THE PROBLEMS YOU ARE FACING ?

1.BURNING PAIN AT ANUS2. BLEEDING DURING OR AFTER DEAFECATION3. ONLY SWELLING WHILE DEAFECATION4. ITCHING AT ANUS5.WEAKNESS AT LITTLE EXERTION6.WEIGHT LOSS7. NONE OF THESE

2. SINCE WHEN YOU ARE SUFFERING FROM THESE PROBLEMS?

1. SINCE 1 OR 2 MONTHS OR LESS THEN THAT2.SINCE 2 – 3 YRS3.MORE THEN THAT4. NONE OF THESE

3. ARE YOU SUFFERING FROM CONSTIPATION / HARD STOOL ?
1.YES2. NO3. NONE OF THESE

4. HOW MANY TIMES YOU GO FOR STOOL / DEFEACATION IN A DAY? 1.NORMAL ONE TIME IN A MORNING2.2 TO 3 TIMES A DAY3. NONE OF THESE

5. STOOL IS ? 1.SATISFACTORY2.UNSATISFACTORY3. NONE OF THESE

6. IS ANYTHING / SWELLING COMING OUT FROM ANUS DURING / AFTER STOOL ? 1.YES2. No3. NONE OF THESE

7. SWELLING – PLS SPECIFY 1. AUTOMATIC SUBSIDES2. REMAINS FOR SOME TIME AND THEN AUTOMATIC GOES INSIDE3. YOU PUT MANUALLY INSIDE4. REMAINS THROUGH OUT DAY5. NONE OF THESE

8. FOR HOW MUCH TIME BURNING / PAIN REMAINS AFTER DEAFECATION ? 1. FOR SOME TIME2. FOR 5 TO 6 HRS3. FOR FULL DAY4. NONE OF THESE

9. HOW YOU GET RELIEF IN BURNING / PAIN ? 1. BY APPLICATION OF HOT WATER2. BY APPLICATION OF COLD WATER3. NONE OF THESE

10. WHETHER BURNING /PAIN IS AGGRAVATED BY CONSUMPTION OF SPICY / NON VEG THINS ? 1. YES2. NO3. NONE OF THESE

11. WHAT IS YOUR NATURE OF JOB ? 1. SITTING / SEDENTARY TYPE2. TOURING JOB3. NONE OF THESE

12. WETHER YOU CONSUME OUTSIDE FOOD VERY FREQUENTLY ? 1. YES2. NO3. NONE OF THESE

13. IF ANY OTHER RELEVANT INFORMATION YOU WANT TO MENTION YOU CAN WRITE HERE SAPERATLY.

14. PLEASE ATTACH ALL THE INVESTIGATION REPORTS ( IF YOU HAVE ANY)

Name
Email
Phone No.

Migraine

1. SINCE WHEN YOU ARE SUFFERING WITH THIS PROBLEM.?

2. WHAT EXACTLY IS HAPPENING TO YOU ?

3. WHICH SIDE YOU HAVE PAIN MORE ? A) RIGHTB) LEFTC) WHOLE HEADC) NONE OF THESE

4. WHAT YOU FEEL ALONG WITH HEADACHE ? A) NAUSEAB) VOMITINGC) NONE OF THESE

5. HOW PAIN STARTS?

6. WHAT IS THE FREQUENCY OF HEADACHE ? A) ONCE OR TWO TIMES IN A WEEKB) ONCE OR TWO TIMES IN 15 DAYSC) ALMOST EVERY DAYD) ALTERNETDAYE) NONE OF THESE

7. WHETHER VOMITING GIVE SOME RELIEF IN HEADACHE ? A)YESB) NOC) NONE OF THESE

8. WHAT ARE THE CONDITIONS WHICH INCREASES THE HEADACHE ? A) SUN LIGHTB) HEAT IN ANY FORMC) MENTAL& PHYSICAL EXERTIOND)TENTIONE) NOISY ENVIORNMENTF) LOSS OF SLEEPG) ANY OTHERH) NONE OF THESE

9. WHAT ARE THE CONDITIONS WHICH DECREASES THE CONDITION ? A) RESTB) SLEEPC) AFTER VOMITINGD) AFTER URINATIONE) APPLICATION OF COLD WATERF) ANY OTHERG) NONE OF THESE

10. WHICH WEATHER YOU PREFER ? A) COLDB) HOTC) NIETHER COLD NOR HOTD) NONE OF THESE

11. WHAT ABOUT YOUR THIRST ? A) THIRSTY – DRINKS LOT OF WATERB) NO THIRST – DRINKS VERY RARELYC) ONLY AT TIMES OF FOODD) NONE OF THESE

12. SINCE HOW LONG YOU ARE TAKING PAINKILLER FOR THE SAME ( IN YEARS)?

13. ANY OTHER RELEVANT INFORMATION / SYMPTOMS WHICH YOU WANT TO SHARE. PLEASE SHARE.

14. ANY INVESTIGATIONS ( IF YOU HAVE ANY) – PLEASE ATTACH

Name
Email
Phone No.

Sciatica & Cervical Spondylosis

1. WHAT ARE YOUR PROBLEMS ?

Describe Here

2. SINCE WHEN YOU ARE SUFFERING WITH THESE PROBLEMS ( IN YEARS) ?

3. ARE YOU HAVING MORNING STIFFNESS (STIFFNESS OF THE REGION ESPECIALLY IN MORNING) ? A) YESB) NOC) NONE OF THESE

4. HOW YOU GET RELIEF FROM MORNING STIFFNESS ? A) AUTOMATICALLY AFTER SOME TIMEB) RUBBING THE PARTC) HOT FOMENTATIOND) COLD APPLICATIONE) PRESSING THE PARTF) NONE OF THESE

5. WHAT IS THE DIRECTION OF PAIN ? A) FROM ABOVE DOWNWARDB) FROM BELOW UPWARDC) RADIATES EVERYWHERE FROM SOURCE POINTD) NONE OF THESE

6. TYPE OF PAIN A) BURNINGB) THROBBINGC)SHOOTINGD) NONE OF THESE

7. REGARDING PAIN – SPECIFY A) PAIN COMES SUDDENLY & GOES SUDDENLYB) PAIN COMESSLOWLY & GOES SLOWLYC)PAIN COMES SUDDENLY & GOES SLOWLYD)PAIN COMES SLOWLY & GOES SUDDENLYE) NONE OF THESE

8. FACTORS WHICH INCREASES YOUR PROBLEMS

9. FACTORS WHICH DECREASES YOUR PROBLEMS

10. THIRST – PLS SPECIFY A) YOU DRINK FREQUENTLYB) YOU DRINK OFTENELYC)YOU DRINK ONLY WITH MEALSD) NONE OF THESE

11. WEATHER – PLS SPECIFY A) PREFER COLDB) PREFER HOTC)NIETHER COLD OR HOTD)COMFORTABLE IN ALL SEASONE) NONE OF THESE

12. FOOD – PLS SPECIFY A)PREFER HOT FOODB) PREFER HOT DRINKSC)PREFER NORMAL FOODD)PREFER COLD DRINKSD) NONE OF THESE

13. BATHING– PLS SPECIFY A)PREFER HOT WATER IN ALL SEASONB) PREFER COLD( TAP) WATER IN ALL SEASONC)SEASONALD) NONE OF THESE

14. STOOL– PLS SPECIFY A)ONE TIMEB) 2-3 TIMESC)SATISFACTORYD) UNSATISFACTORYE)HARDF)SOFTG)SEMI LIQUIDH)OFFENSIVEI)NON OFFENSIVEJ)PASSES WITH FLATUS WITH FLUTTERING NOISEK) NONE OF THESE

15. PLEASE ATTACH ALL THE INVESTIGATION REPORTS ( IF YOU HAVE ANY)

16. IF ANY OTHER RELEVANT INFORMATION YOU WANT TO MENTION YOU CAN WRITE HERE SAPERATLY.

Describe Here

Name
Email
Phone No.

Female Diseases

1. WHAT ARE YOUR PROBLEMS ?

2. SINCE WHEN YOU ARE SUFFERING WITH THESE PROBLEMS ( IN YEARS) ?

3. IF YOU FEEL PAIN THEN SPECIFY A) PAIN GOES FROM FRONT TO BACKB) PAIN GOES BACK TO FRONTC)PAIN IN SIDESD) NONE OF THESE

4. TYPE OF PAIN A) BURNINGB) THROBBINGC)SHOOTINGD) NONE OF THESE

5. REGARDING PAIN – SPECIFY A) PAIN COMES SUDDENLY & GOES SUDDENLYB) PAIN COMESSLOWLY & GOES SLOWLYC)PAIN COMES SUDDENLY & GOES SLOWLYD)PAIN COMES SLOWLY & GOES SUDDENLYE) NONE OF THESE

6. COLOUR OF DISCHARGE A)BLACKISHB) BRIGHT REDC) BROWNISH – IN CASE OF LEUCORRHOEAD)WATERY – IN CASE OF LEUCORRHOEAE) MILKY – IN CASE OF LEUCORRHOEAF) NONE OF THESE

7. TYPE OF DISCHARGE A) CLOTTEDB) UN CLOTTEDC) EASILY WASHABLED) STICKYE) STRINGYF) OFFENSIVE ( MENTION IF PARTICULAR SMELL)G) NON OFFENSIVEH) NONE OF THESE

8. FACTORS WHICH INCREASES YOUR PROBLEMS/FLOW (LEUCORRHOEA/MENSES)

9. FACTORS WHICH DECREASES YOUR PROBLEMS/FLOW (LEUCORRHOEA/ MENSES)

10. THIRST – PLS SPECIFY A) YOU DRINK FREQUENTLYB) YOU DRINK OFTENELYC)YOU DRINK ONLY WITH MEALSD) NONE OF THESE

11. WEATHER – PLS SPECIFY A) PREFER COLDB) PREFER HOTC)NIETHER COLD OR HOTD)COMFORTABLE IN ALL SEASONE) NONE OF THESE

12. FOOD – PLS SPECIFY A)PREFER HOT FOODB) PREFER HOT DRINKSC)PREFER NORMAL FOODD)PREFER COLD DRINKSE) NONE OF THESE

13. BATHING– PLS SPECIFY A)PREFER HOT WATER IN ALL SEASONB) PREFER COLD( TAP) WATER IN ALL SEASONC)SEASONALD) NONE OF THESE

14. STOOL– PLS SPECIFY A)ONE TIMEB) 2-3 TIMESC)SATISFACTORYD) UNSATISFACTORYE)HARDF)SOFTG)SEMI LIQUIDH)OFFENSIVEI)NON OFFENSIVEJ)PASSES WITH FLATUS WITH FLUTTERING NOISEK) NONE OF THESE

15. PLEASE ATTACH ALL THE INVESTIGATION REPORTS ( IF YOU HAVE ANY)

16. IF ANY OTHER RELEVANT INFORMATION YOU WANT TO MENTION YOU CAN WRITE HERE SAPERATLY.

Name
Email
Phone No.

Hair Fall

1. SINCE WHEN YOU ARE FACING THE PROBLEM OF HAIR FALL ( IN YEARS)?& HOW IT STARTED

2. PLEASE SPECIFY WHEN IT STARTED A)AFTER ANY MEDICATIONB) STRESSC) AFTER DELIVARYD)AFTER CHANGING HAIR CARE PRODUCTS ( OIL, SHAMPOO, HAIR COLOUR)E)AFTER ANY SCALP INFECTIONF)DANDRUFFG)AFTER ANY CHRONIC DISEASEH)AFTER CHRONIC HEADACHEI) NONE OF THESE

3. WHAT IS THE QUALITY OF WATER IN YOUR AREA ? A) HARDB) SOFTC) NONE OF THESE

4. WETHER YOU GET ITCHING AT SCALP.? A) YESB)NOC) NONE OF THESE

5. IS THERE ANY PUS FORMATION AND PAIN AT YOUR SCALP?

6. ARE YOU SUFFERING WITH DANDRUFF ALSO ALONG WITH HAIR FALL? A)YESB) NOC) NONE OF THESE

7. WHETHER DANDRUFF FALLS OUT FROM YOUR HAIR WHEN YOU SCRATCH YOUR SCALP ? A)YESB) NOC) NONE OF THESE

8. WHETHER HAIR FALL IS SINCE BIRTH OR IMMEDIATE AFTER BIRTH A)YESB) NOC) NONE OF THESE

9. HOW MANY TIMES YOU WASH YOUR HAIR IN A WEEK ?

10. ARE YOU SUFFERING WITH VIT D DEFICIENCY? A)YESB) NOC) NONE OF THESE

11. ARE YOU SUFFEREING WITH VIT B 12 DEFICIENCY? A)YESB) NOC) NONE OF THESE

12. ARE YOU CHANGING YOUR SHAMPOO / COSMETIC PRODUCTS VERY FREQUENTLY ?

13. WHAT IS THE TEXTURE OF YOUR HAIR? WHETHER IT IS A)DRY , THIN & LUSTERLESSB) SHINY & DENSEC) NONE OF THESE

14. ARE YOU ALLERGIC TO ANY MEDICINE / SUBSTANCE ? A)YESB) NOC) NONE OF THESE

15. HOW MUCH QUANTITY OF HAIR FALL IS THEIR ?

16. IS IT MORE AFTER HEAD WASH ? A)YESB) NOC) NONE OF THESE

17. IS YOUR HAIRS ARE GETTING THIN AND SPLITTINGS ? A)YESB) NOC) NONE OF THESE

18. ARE HAIRS COMING OUT IN BUNCHES AND LEAVING BALD AND SMOOTH AREA? A)YESB) NOC) NONE OF THESE

19. WHICH WEATHER YOU PREFER ? A)COLDB) HOTC)NIETHER COLD NOR HOTD) NONE OF THESE

20. WHAT ABOUT YOUR THIRST ? A)THIRSTY – DRINKS LOT OF WATERB) NO THIRST – DRINKS VERY RARELYC)ONLY AT TIMES OF FOODD) NONE OF THESE

21. ANY OTHER RELEVANT INFORMATION / SYMPTOMS WHICH YOU WANT TO SHARE. PLEASE SHARE.

22. ANY INVESTIGATIONS ( IF YOU HAVE ANY) – PLEASE ATTACH

Name
Email
Phone No.

Pimples

1. SINCE HOW LONG YOU ARE SUFFERING FROM PIMPLES ( IN YEARS /MONTHS)?

2. IS IT PAINFULL ? A) YESB) NOC) NONE OF THESE

3. WHETHER YOU FEEL ITCHING IN IT ? A) YESB) NOC) NONE OF THESE

4. WHETHER PUS IS PRESENT OR NOT ? A) PRESENTB) NOT PRESENTC) NONE OF THESE

5. IF YES, WHAT IS THE COLOUR OF PUS ? A) WATERYB) CREAMISH LIGHT YELLOWC) GREENISHD) NONE OF THESE

6. WHETHER PUS IS OFFENSIVE ? A) YESB) NOC) NONE OF THESE

7. HOW MANY PIMPLES IN A WEEK ( ON AN AVERAGE) ?

8. IS THERE ANY EFFECT OF PERIODS/ MENSES ON IT ? A) YESB) NOC) NONE OF THESE

9. WHEN IT IS MORE IN NOS ? A) BEFORE MENSESB) DURING MENSESC) AFTER MENSESD) NONE OF THESE

10. WHAT ABOUT YOUR SKIN OF FACE ? A) IT IS OILY AND GREASYB) IT IS DRY AND ROUGHC) NONE OF THESE

11. WHETHER YOU USE ANY CREAM / COSMETICS ? A) YESB) NOC) NONE OF THESE

12. WHETHER YOU FREQUENTLY CHANGE THE BRANDS OF YOUR COSMETICS? A) YESB) NOC) NONE OF THESE

13. ARE YOU SUFFERING WITH CONSTIPATION ? A) YESB) NOC) NONE OF THESE

14. WHAT ABOUT YOUR STOOL, HOW MANY TIMES YOU GO TO STOOL.? A) ONLY ONCEB) 2 – 3 TIMES A DAYC) NONE OF THESE

15. IS IT SATISFACTORY ? A)YESB) NOC) NONE OF THESE

16. WHICH WEATHER YOU PREFER ? A) COLDB) SUMMERC) SPRINGD) RAINYE) NONE OF THESE

17. HOW IS YOUR THIRST ? A) THIRSTY – DRINKS LOT OF WATERB) NO THIRST – DRINKS VERY RARELYC) ONLY AT TIMES OF FOODD) NONE OF THESE

18. ANY OTHER RELEVANT INFORMATION / SYMPTOMS WHICH YOU WANT TO SHARE. PLEASE SHARE.

19. ANY INVESTIGATIONS ( IF YOU HAVE ANY) – PLEASE ATTACH

Name
Email
Phone No.

Dental care

1. SINCE WHEN YOU ARE FACING THE PROBLEM OF HAIR FALL ( IN YEARS)?& HOW IT STARTED

2. PLEASE SPECIFY WHEN IT STARTED A)AFTER ANY MEDICATIONB) STRESSC) AFTER DELIVARYD)AFTER CHANGING HAIR CARE PRODUCTS ( OIL, SHAMPOO, HAIR COLOUR)E)AFTER ANY SCALP INFECTIONF)DANDRUFFG)AFTER ANY CHRONIC DISEASEH)AFTER CHRONIC HEADACHEI) NONE OF THESE

3. WHAT IS THE QUALITY OF WATER IN YOUR AREA ? A) HARDB) SOFTC) NONE OF THESE

4. WETHER YOU GET ITCHING AT SCALP.? A) YESB)NOC) NONE OF THESE

5. IS THERE ANY PUS FORMATION AND PAIN AT YOUR SCALP?

6. ARE YOU SUFFERING WITH DANDRUFF ALSO ALONG WITH HAIR FALL? A)YESB) NOC) NONE OF THESE

7. WHETHER DANDRUFF FALLS OUT FROM YOUR HAIR WHEN YOU SCRATCH YOUR SCALP ? A)YESB) NOC) NONE OF THESE

8. WHETHER HAIR FALL IS SINCE BIRTH OR IMMEDIATE AFTER BIRTH A)YESB) NOC) NONE OF THESE

9. HOW MANY TIMES YOU WASH YOUR HAIR IN A WEEK ?

10. ARE YOU SUFFERING WITH VIT D DEFICIENCY? A)YESB) NOC) NONE OF THESE

11. ARE YOU SUFFEREING WITH VIT B 12 DEFICIENCY? A)YESB) NOC) NONE OF THESE

12. ARE YOU CHANGING YOUR SHAMPOO / COSMETIC PRODUCTS VERY FREQUENTLY ?

13. WHAT IS THE TEXTURE OF YOUR HAIR? WHETHER IT IS A)DRY , THIN & LUSTERLESSB) SHINY & DENSEC) NONE OF THESE

14. ARE YOU ALLERGIC TO ANY MEDICINE / SUBSTANCE ? A)YESB) NOC) NONE OF THESE

15. HOW MUCH QUANTITY OF HAIR FALL IS THEIR ?

16. IS IT MORE AFTER HEAD WASH ? A)YESB) NOC) NONE OF THESE

17. IS YOUR HAIRS ARE GETTING THIN AND SPLITTINGS ? A)YESB) NOC) NONE OF THESE

18. ARE HAIRS COMING OUT IN BUNCHES AND LEAVING BALD AND SMOOTH AREA? A)YESB) NOC) NONE OF THESE

19. WHICH WEATHER YOU PREFER ? A)COLDB) HOTC)NIETHER COLD NOR HOTD) NONE OF THESE

20. WHAT ABOUT YOUR THIRST ? A)THIRSTY – DRINKS LOT OF WATERB) NO THIRST – DRINKS VERY RARELYC)ONLY AT TIMES OF FOODD) NONE OF THESE

21. ANY OTHER RELEVANT INFORMATION / SYMPTOMS WHICH YOU WANT TO SHARE. PLEASE SHARE.

22. ANY INVESTIGATIONS ( IF YOU HAVE ANY) – PLEASE ATTACH

Name
Email
Phone No.

PROF. DR. RAJAN SINGH SOOD ( B.Sc. BHMS, MD, PGDHHM, M.PHILL ( HOSPITAL HEALTH SYSTEM), PhD.)

Our Address:

Working Time

1. ON CAll - HOMOEOPATHY

24*7 ALL WEEK DAYS)

1. HOMOEOPATHY -
MONDAY - SATURDAY - 5 PM - 9 PM
SUNDAY - 9 AM - 12 AM

2 .DENTAL -
MONDAY - SATURDAY - 9 AM -12 PM
                                        - 5 PM - 9 PM

SUNDAY                         - 9 PM - 12 PM
          (ONLY BY PRIOR APPOINTMENT)

Contact Details:

Our Address:

DAFFODILS POLY CLINIC
3- B, BLOCK, AMBEDKAR COLONY, LINK ROAD,
SECTOR – 14, UDAIPUR. RAJASTHAN. 313001.

Phone No:

+91-7728930767

Mail id:

info@rajan-sood.com

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