How often do you pass motions ?More than once a dayOnce a dayNot Daily
What is the consistency of your stools ?LooseWell FormedNot Sure
Do you pass motions after eating ?YesNoOccassionally
Do you get a stomach pain before passing motions ?YesNoOccasionally
Do you get a stomach pain after passing motions ?YesNoNot Sure
Is there mucous in your stools ?YesNoOccasionally
Do you pass blood in your stools ?YesNoOccasionally
Do you suffer with frequent bouts of loose motions?YesNoOccasionally
Does your stomach rumble ?YesNoOccasionally
Does your stomach feel bloated?YesNoOccasionally
Do you eat out frequently?YesNoOccasionally
Do you suffer with loose motions on eating out ?YesNoOccasionally
Have you got any investigation done ? (Please mention the reports in the 'more symptoms' column at the end of the questionnaire)YesNo
Are you already a patient with Dr.Manoj's Homeopathy? If yes please give your Registration Number in the text box.YesNo
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