Patient’s name:
Encino Acu-Medical Center
Dr. Salar Farahmand
Patient’s name:
Age:
Date:
Phone:
Gallbladder Disorders (Questionnaire)
[pic]Aching joints and muscles
[pic]Yellow discoloration of eyes and skin
[pic] Sinus Congestion
[pic] Fat Intolerance
[pic] Constipation
[pic] Increase abdominal gas
[pic] Pain under the right rib cage
[pic] Toxicity from chemotherapy
[pic] Toxicity from intra-hepatic bile duct drugs
[pic] Anger and frustration
[pic] Occipital headaches
[pic] Neck pain
Pain in the right shoulder
[pic] Dizziness
[pic] Bitter taste in the mouth
[pic] Allergies
[pic] Feeling heaviness or discomfort after eating fatty or fried food
[pic] Feeling uncomfortable after eating certain fruits
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