Ruqyah Diagnostic Questionnaire

Peace be upon you, and the mercy and blessings of Allāh. For accurate diagnosis via Qur'ān, Prophetic Medicine, herbs and alternative medicine, please answer the following questions honestly.

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1. Frequent and heavy hair loss (for women)?

2. Frequent pain between the shoulders, in the lower back, joints? Excessive nervousness/irritability?

3. Digestive symptoms — choose ONE:

4. Limb / spiritual symptoms — choose all that apply:

5. Frequent sexual dreams / nightmares?

6. Masturbation addiction?

7. Frequent miscarriages, or dreams of boys dying while girls survive (women)?

8. Hormonal imbalance or irregular menstrual cycles (women)?

9. Temporary infertility (both spouses medically healthy, tests fluctuate)?

10. PCOS in women?

11. Frequent marital problems, feelings of mutual repulsion?

12. Erectile dysfunction / sexual weakness?

13. Feeling suffocated during prayer or while reading the Quran?

14. Delay in marriage (no desire / no success / suffocation when meeting suitor)?

15. Marital status?

16. Recurring dreams (graves, dead people, animals, exam failure, falling, flying, eating)? Specify in notes.

17. Spiritual heaviness — choose all that apply:

18. Sinus / nasal symptoms during Ruqyah?

19. Tasfeeh / Pharaonic Circumcision performed on you (women only)?

20. Tingling at base of head, thoughts of death, fear of night, feet heavy as if dragged?

Other notes — recurring dreams, illnesses, comments:

By submitting you allow Islamic Cure & Care to use these answers solely for spiritual & medical diagnosis. We never share your data with third parties.