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Homoepathy - The science of healing the body, mind and soul

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Name:
Email Id:
Contact no:
Location:
Occupation:
Suffering from:
Suffering Since :
Started By:
Complaints increased by/when:
Complaints better by/when:
Any Family History with same:
Father/mother Major illness:
Treatments tried earlier:

Tick from the below:
Allopathy
Homoeopathy
Ayurvedic

Results got were satisfactory?
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Homeopathic Concept of Yours :