Treatment by Correspondence :

In ordinary cases, Correspondence treatment is given. Questionnaire is supplied by Arogya Mandir to be replied by patient. Monthly fee charges are Rs. 300/-. All letters are replied during this period

The format of Questionnaire is given bellow.

Questionnaire :

To
The Director
Arogya Mandir,
(Nature-Cure Hospital),
P. O.: Arogya Mandir,
Gorakhpur - 273 003 (U. P.) INIDA.

1. Name: _______________________________________________________________

2. Full Address: __________________________________________________________

                         __________________________________________________________

3. Age & Education: _______________________________________________________

4. Height & Weight:
                                          At present                                Before Disease

                           Height: _____________                  Height: _____________

                           Weight: _____________                 Weight: _____________

5. Married or unmarried: ____________________________________________________

6. Occupation - Its duty hours? How spent - Sitting Deskwork or Movement field work?
___________________________________________________________________________

7. Period of rest, sleeping time at night and rising time in the morning. Quality of sleep -
deep or disturbed: ____________________________________________________________

8. What and how much do you eat; at what time do you eat? ______________________
___________________________________________________________________________

9. Number of times bowels are cleared? Type - Solid or loose? ____________________

10. Do you suffer from constipation? Are their itching, boils, rashes on the body? ___________________________________________________________________________

11.Taste of mouth, colour of toung: __________________________________________ __________________________________________________________________________

12. Any addiction - Biri, Cigarette, Tobacco, sniffing/orally, Ganja, Opium, alcohol, Betel- leaves, Betelnuts, Smack/hashis etc.: ___________ ___________________________________________________________________________

13. Mental status - worries free or worry some: _________________________ ___________________________________________________________________________

14. History of the case from beginning: ______________________________________
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

15. Diagnosis by Doctors: _______________________________________________
_________________________________________________________________________
_________________________________________________________________________

16. Is illness permanent or intermittent? _________________________________ ___________

17. Present symptoms of diseases: _______________________________________ __________

18. Hereditary disease in your family: _________________________________ _____________

19. If fever - when and how much: ________________________________ _________________

20. Eye sight - week or strong; spectacles used, its power: ____________________________

21. Dental condition: ___________________________________________________ ___________________

22. Do you perform Worship, prayer or meditation: ____________ _______________________

23. Have you gone through nature-cure; name the books: ____________________
__________________________________________________________________________

24. If taken nature-cure treatment - its description: ___________________________
___________________________________________________________________________

25. Seasonal fruits/vegetables of your place: _________________________ ___________________

26. Temperature of town/place: _________________________________ __________________________________________________________________________

27. Any other special mention: _____________________________________________________ __________________________________________________________________________

For Ladies use only

1. Menstruation’s - timely or untimely - duration; Any unnaturality: _________________________________________________________________________
_________________________________________________________________________
2. Have suffered from leukorrhoea: ____________________________ ________________________

3. Has or how has it been treated? _________________________ _________________________

4. Suffered abortion? ______________________________________________ _________________________________________________________________________

Space for special details