pigmentation since ? WeeksMonthsYears
Itching at the pigmented area YesNoOccasionally
Family history of similar pigmentation YesNoNot Sure
Has it been spreading over the years YesNoNot Sure
Has it been getting darker over the years YesNoNot Sure
Does it increase on exposure to sunlight ? YesNoOccasionally
periods(if irregular pl mention in detail in the more symptoms column) RegularIrregular
Photograph is being attached YesNo
Redness in the affected area? YesNo
Any investigations done?(please mention the reports in the more symptoms column) YesNoOccasionally
Are you an existing patient with Dr.Manoj's Homeopathy? If yes please give your Reg.No. in the more symtoms column. 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: