Elysion Improving | General questionnaire

General questionnaire

Welcome to general questionnaire

Medical questionnaire is crucial in evalution of client's health condition and proposing a proper medical treatment. Please fill that medical queationnaire below which is related to what kind of medical care you are looking for so we can start the process of the medical care as soon as possible.

General Questionnaire

GENERAL INFORMATION

ADDITIONAL INFORMATION

SPECIFICATION OF THE PATIENT'S MEDICAL CONDITION

Do you experience pain when resting/sleeping?

Yes

Do you experience pain during everyday activities?

Yes

Does the pain intensify during more intensive activities?

Yes

MEDICATION

YOUR SPECIAL REQUIREMENTS AND ANY OTHER INFORMATION YOU CONSIDER IMPORTANT

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I agree with the principles of personal data processing