Fill data diagnosed (the one who in a photo), thus columns noted
*
- without fail, the others on your discretion.
*
Your Email
*
Repeat Email
*
date of birth (dd.mm.yy)
*
name
last name
patronymic
*
height (rough)
height
100
110
120
130
140
150
155
160
165
170
175
180
185
190
*
weight (rough)
weight
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
120
130
140
160
*
the inhabitant cities
or villages
*
region
*
choose interesting organ or a body part
choose
Head (brain)
Eyes (sight)
Ears (hearing )
Throat+nose
Thyroid gland
Lungs
Heart
Thorax (pectoral)
Breast
Backbone
Stomach
Pankreas
Liver
Bilious bubble
Spleen
Bowels
Kidneys
Uterus
Ovaries
Prostate
Extremities
*
In which hour wake up?
choose
6.00
7.00
8.00
9.00
10.0
11.00
12.00
*
When you fall asleep?
choose
21.00
22.00
23.00
24.00
1.00
2.00
3.00
*
How many do you eat one time per a day?
choose
1
2
3
4
5
*
Your middle pressure
choose
220
200
180
160
150
140
130
120
110
100
90
80
lower
140
130
120
110
100
90
80
70
60
50
*
middle pulse
choose
140
130
120
110
100
90
80
70
60
50
*
state of teeth
choose
good
middle
prosthetic
*
acceptable water for bathing
choose
hot
warm
cool
*
emotionality
choose
very
not very much
indifferent
*
what music is anymore liked
choose
pop
classic
jazz
whether did to you an operation and what
(describe)
If you wish to add data or to inform something on yours healthy enter here:
*
attach a file with a photo (a format of file JPG, JPEG, BMP, the size no more 1500x1300 and not less 800x800)