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..

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



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