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Admin
Create SMS
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View SMS
Campaign
Add Campaign
View Campaign
Leads
Current Leads
To be Called
Interested Leads
Sent to Assesment
Invalid Leads
Add Manual Lead
Import Manual Lead
Archive Leads
Agreement
Pending Agreement
Live Agreement
Expired Agreement
Report
Source wise Leads Status
Date wise Leads Status
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SYSTEMS REVIEW
Have you had any of the following problems in past month ?
Genaral
-- Select --
Recent weight gain
Recent weight loss
Fatigue
Weakness
Fever
Night sweats
Psychiatric
-- Select --
Depression
Difficulty falling asleep
Food cravings
Difficulty staying asleep
Difficulties with sexual arousal
Poor appetite
Frequent crying
Sensitivity
Thoughts of suicide/attempts
Poor concentration
Racing thoughts
Hallucinations
Rapid speech
Guilty thoughts
Paranoia
Mood swings
Anxiety
Stress
Irritability
Nervous system
-- Select --
Headaches
Dizziness
Memory Loss
Fainting or loss of consciousness
Numbness of tingling
Kidney/Urine/Bladder
-- Select --
Frequent or painful urination
Blood in Urine
Anemia
Ears
-- Select --
Ringing in ears
Loss of hearing
Stomach and Intestines
-- Select --
Nausea
Heartburn
Stomach pain
Vomiting
Yellow jaundice
Increasing constipation
Persistent diarrhes
Blood in stools
Black stools
Muscle/Joints/Bones
-- Select --
Numbness
Join pain
Muscle weakness
Join swelling
Women only
-- Select --
Abnormal pap smear
Irregular period
PMS
Bleeding period
Heart and Lungs
-- Select --
Chest pain
Palpitations
Shortness of breath
Fainting
Throat
-- Select --
Frequent sore throats
Hoarseness
Pain in jaw
Difficulty in swallowing
Eyes
-- Select --
Pain
Redness
Loss of vision
Dryness
Double or blurred vision
Skin
-- Select --
Redness
Rsah
Nodules/bumps
Hair loss
Color changes of hands
Women's Reproductive History
Age of first period
Pregnancies
Miscarriages
Abortions
Reached menopause
Yes
No
Regular Periods
Yes
No
Substance Use
1. Alcohol
Age when
How much & how often
How many years
Currently
Yes
No
2. Smoking
Age when
How much & how often
How many years
Currently
Yes
No
3. Cannabis
Age when
How much & how often
How many years
Currently
Yes
No
4. Other
Age when
How much & how often
How many years
Currently
Yes
No
