Meet Fistula in Ano
Specialist
For 100% Permanent & Natural Cure.
Free Consultation for Anal Fistula(Fistula in Ano)
Name
Email
Mobile
Age
Sex
Male
Female
Address
Profession
Marital Status
Married
Unmarried
Single
Divorcee
Education
Blood Pressure
Weight
Kilograms
Height
Feet
Inches
Are You
Vegetarian
Non-Vegetarian
You are Dependent on
Alcohol
Smoking
Drugs
Coffee/Tea
Type of Discharge ?
( What type of material is coming from the external opening of fistula ?)
Blood
Pus
Faeces
Gas
Urine
Type of Pain ?
Pricking
Cutting
Throbbing
Burning
Onset of disease ?
Acute
Gradual
Duration of disease ?
Less Than One Year
More Than One Year
Bowel Habit (Condition of stomach)
Normal
Constipated
Mucous
Mucous & Blood
History of Trauma
Previous Surgery
(Have you ever been operated) ?
Yes
No
Condition of Skin Near Fistula in Ano ?
Normal
Inflammed
Indurated
Ext. Piles or Tag
Tenderness
(pain around the external opening)
Present
Abscent
Main Complaint
Personal History
Laboratory Investigation Reports
(if any like blood sugar, BTCT )
Other information,might be helpful
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