suffering since ? WeeksMonthsYears
Have you been in contact with anyone with molluscum YesNoNot Sure
Itching in the lesion YesNoOccasionally
pain in the lesion YesNoOccasionally
Are new ones coming up YesNoNot Sure
Have you got them removed anytime YesNo
Have you had them anytime before in life YesNoNot Sure
Any investigation done Yes No (pl mention in the more symptoms column,pl attach a photo of the lesion ) 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: