Académique Documents
Professionnel Documents
Culture Documents
1. Name :
2. Age :
3. Sex : Male / Female
4. Address :
Town / City :
State :
Zip / Pincode :
5. Home phone :
6. Work phone :
7. Cell phone :
8. E-mail :
9. Occupation :
10. Present medical condition :
1
12. Purpose of visit :
recommended?
3
------------------------------------------ FOR OFFICIAL USE ONLY ----------------------------------------
4
Pranic healing diagnosis
Front heart
Back heart
Basic
Sex
Navel
Meng mein
Throat
Sec throat
Ajna
Forehead
Crown
Back head
Jaw minor
Hip minor
Knee minor
Sole minor
Armpit minor
Elbow minor
Palm minor
5
24. Treatment goal
Short term goal :
Duration of treatment :
Number of treatment :
sessions / week