Since when have you been having red eye?DaysWeeksMonthsYears
Is there a sticky discharge from the eye?YesNo
Is there any pain in your eyes?YesNo
Is there any watering from your eyes?YesNo
Have you been in contact with someone with red eye recently?YesNoNot Sure
Does the redness become more when you go into the sun?YesNo
Do you suffer from sneezing bouts or a running nose or itching in the eyes?YesNoOccasionally
Have you got any investigations done?(please mention the details of the reports in the 'more symptoms' column)YesNo
Are you an existing patient with Dr.Manoj's Homeopathy? If yes please mention your registration number down.YesNo
Name:
Email Address:
Contact Number:
Location/City:
Gender:MaleFemale
Age:-Select-1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 Months234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798
More Symptoms:
