Blood pressure level very high.

Kindly fill this FORM so doctor can understand your health history Just Copy & Paste here, then add your information before pressing send.. Or download form from link below < ONLINE CONSULT CONSENT FORM > 1. Patient Name : 2. Age : 3. Sex : 4. Location : 5. Contact no : 6. Occupation : 7. Height : 8. Weight : (Personal History) 1. Smoking : 2. Alcohol : 3. Tobacco chewing : 4. Any other : (Daily Routine) 1. Hours of sleep : 2. Veg / NonVeg / Egg : 3. Water intake in lts : 4. How much salad : 5. Milk & Dairy per day : 6. Sun Exposure time : 7. Any Physical Activity : 8. Exercise Intensity & duration: 9. Any Mental Stress : 10. How many tea / coffee : 11. Approx Protein Intake : (Medical History - yes/no) 1. Diabetes : 2. Hypertension : 3. Thyroid Problems : 4. Asthma / COPD : 5. Any Allergies : 6. Arthritis : 7. TB / Tuberculosis : 8. Any other disease : 9. Any past surgery : 10. Any present Medications : 11. How many floors / stairs can you climb easily : (Present Health Concern) 1. What is the problem: 2. Since when : 3. Any tests already done (send reports) 4. Any treatment taken (attach latest prescription) 5. Is the problem increasing or decreasing? 6. Any other symptoms 7. Any other relevant information : I hereby agree & consent for this online consultation. I am aware that healthcare advice will be provided through telephonic or Internet consultation with the Doctor and that there will be no physical examination. I agree that the diagnosis based on telephonic consultation will be at a pre-primary level and that I will visit another doctor either as directed by Dr. Paramjeet or a doctor of my choice for further treatment. And I am ready to pay the doctor's fees for this consultation Write your Name or sign : Date: You can also Download this form from here. https://drive.google.com/file/d/1-gdb0cuu-qdhhpa0n9vxwuiwsjwqh3h2/view?usp=drivesdk