Questionnaire for collecting Ethnomedicinal data during Ethnobotanical Study
Questionnaire:
Informants consent for the participation in the study:
I..................................................... (name of informant) hereby give my full consent and conscious to participate in this study and declare that to the best of my knowledge the information that I have provided are true, accurate and complete.
Date........................................ (Signature/Thumb impression of Informant)
Informants details:
Name................................................................................................
Gender..............................................................................................
Age...................................................................................................
Occupation.........................................................................................
Education..........................................................................................
Location/Residence.............................................................................
Data about medicinal plant and its use:
Plant (Local name).............................................................................
Habit (Tree/ Herb/ Shrub/Climber/...)
Plant part used...................................................................................
Cultivated/ Wild................................................................................
If cultivated, cultivated for.....................
If wild, availability in natural resources (easy/ difficulty/ very difficult)
Conservation needs ...........................................................................
Conservation efforts made by Government and local residents..
Conservation needs ...........................................................................
Conservation efforts made by Government and local residents..
Method of collection and storage.......................
Name of disease(s) treated........................
Method of crude drug preparation........................................................
Mode of administration.......................................................................
Dosage .................................................................. .........................
Other uses (if any).................................
Remarks:
Plant identified as (Botanical name and family)
Signature of Researcher
