Since how long have you been suffering with this problem ? WeeksMonthsYears
Do you have a nose block ?
YesNoOccasionally
Which side is the block mostly on ? RightLeftBothAlternates
Is your sense of smell intact ? YesNoOccasionally
Is it associated with headache ? YesNoOccasionally
Do you have a frequent cold ? YesNoOccasionally
Do you have a frequent fever ? YesNoOccasionally
Is the polyp visible when you look into the nostrils ? YesNoOccasionally
If yes, on which side ? RightLeftNot visible
Do you have any sneezing bouts ? YesNoOccasionally
Have you got any investigation done (If yes, then please write the details of the reports in the 'more symptoms' column)
YesNo
Are you already a patient with Dr. Manoj's Homeopathy? If yes, then please state your Registration Number in the 'more symptoms' column.
Name:
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Gender:MaleFemale
Age:-Select-1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 Months234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798
More Symptoms:
