SafaCura Healthcare Quotation

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SafaCura provides free healthcare quotation to people who has gotten sickness and uncomfortableness.

Please enter the following information:

Patient Name:
Your relationship with patient:
Patient Date of Birth (Help evaluate constitution of body): Year: Month: Day : Hour: Minute: (Write "00" if you don't know)

Patient Address (Help evaluate living environment):

Your email address (For communication only):

Symptoms (Describe what painful or uncomfortableness are):

Previous diagnosis (Describe what previous diagnosis, including chinese or western medicine, patient had taken):

Feel (cold or hot, place of pain and/or itch, dizzy, paint, tinnitus, etc.)

Eat (not well, well but hungry easily, hungry but not want to eat, like to eat certain kinds of food suddenly, etc.)

Drink (feel thirsty or not, want to drink or not, etc.)

Sleep (well or not, dream, feel tire even sleep, etc.)

Feces (easy or difficult, frequent or not, hard or soft, wet or dry, with a lot of water or not, with blood or not, smell, etc.)

Urine (easy or difficult, frequent or not, color, etc.)

Menstrual (earlier or later, frequent or not, too much or very little, color, sanitary pad or not, pain, etc.)

Phlegm (easy or difficult to cough out, frequent or not, color, with blood or not, etc.)

Vomit (easy or difficult to vomit out, frequent or not, color, smell, with digested food or undigested food, blood, etc.)

Sweat (frequent or not, taste, color, etc.)

Pregnant (pregnancy, with difficult or not, etc.)

Please email patient photos (face, whole body, tongue, skin, etc, for diagnosis if necessary) to

If you have any other enquiry, please contact .

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