Ask Dr. Deoshlok Sharma

Ask Dr. Deoshlok Sharma 

Please Write your detail Sign & Symptoms, Current complain or you can use separately sheet
(copy it and pest in your word pad and write carefully in a detail and send it to us by email deoshlok (AT) gmail.com


1.Name ————–
2.Address————
3. City—————
4.Country—————
5.Phone—————
6 Mobile—————
7.Email —————
8.Age-
9.Male/Female—————
10.Weight—————
11.Height—————
12.What are you doing at present…………………………..
13..Single/Married/Separated/Divorced/Widow/widower—————
14.Describe your current complain—————

What exactly is happening ?

How do you feel ?

How does this affect you ?

How does it feel like ?

. What comes to your mind ?

. One situation that had a big effect on you ?

. How did that feel like ?

. What sensation do you experience in that situation ?

. What are you showing by that gesture of your hand.(habits or Action) ?

15.Describe your Past complain/Any surgery-
16.Write your pathological report (Blood test Ultra sonography / MIR/ X-ray, if any (optional) if any.————–..
17.High Blood Pressure Continue from and current B.P.—————
18.If any heart Disease
19 Name of medicine using currently——-
20.If Diabetic Patient/Name of medicine—————
21.Insulin Dependent/Doses—————
22.Detail about Operation/Surgery if any —————
23.Thyroid Problem if any T3/T4/TSH—————

24.Female
a Any Gynecology Problem (Write in Detail) ————–
b. Is there is any pain in the Breast before menses—————
c. Is there is any Tumor/Fibroid/ in Breast/Uterus—————
d. Is there is White discharge (Leucorrhoea)—————
e. Is there is pain during mating——————
f. Is there is habit of Masturbation—————-
g. About Your sexual desire increased/absent/normal———
h. Is there is any itching/scratching of your gyneic area——–
i. Flow of your menses————-

25. Male
a. Is there is any infection/ulceration/eruption on your pubis
b. is there is any seminal discharge during stool
c. Is there is any discharge during talking from female
d. Is there is any itching/scratching on groin region
e. About Your sexual desire increased/absent/normal———

26.Gastritis—————
27.Joints pain—————
28.Swelling—————
29.Any Other Disease—————
30. About Your sexual desire increased/absent/normal————–

31.Choose your nature from following word —————
Mental Symptoms:-(Compulsory)-Morose, Quarrelsome, Hasty, Lachrymose, Anxious, Delirious, Groping, Despairing, Sad, Hopeful, Fearful, Restless, Calm, Drowsy, dullness, Anger, Being overwhelmed, Depression and gloom Despair and faithlessness , Despondency from overwork, Domination of others, Doubt or Discouragement, Easy impressionability, Fear and Shyness, Fear for the others welfare, Fear of losing mental balance, Feeling of powerlessness, Guilty and self-blame, Hard master onto oneself with an urge to inspire others, Hopelessness, Immaturity of Mind/Emotions, failure to learn from mistakes impatience, indecision in difference or boredom Intolerance and criticism lack of mental tranquility, lack of motivation and incentive longing for past happiness, nostsliqia, low self-confidence, Mental Fatigue, Mental torture or worry, Mental/emotional and physical weariness, Overcome for welfare of others, Overenthsiasm, Pride or aloofness, Resentment and bitterness, Sadness, greif, shock, Self centered talkativeness, Self-distrust, Shame or feelings of un cleanliness, Terror, jealousy, Weakness too willing , Fear from known thing, fear from unknown thing.

32.(in case of married) Is there your husband/Wife is cooperating to you or not any friction write in detail——————

33. What is your current anxiety in your mind (compulsory)- Write in detail————–

34. How you will be deference from other person or What is your peculiarity in nature————–

35. Can you give speech to the public meeting————-

Photographs of the current Disease can be sent by email separately on (optional)