Since how long have you been having a nosebleeds ?
How frequently do you have a nosebleeds ?
Once a yearTwice a yearMore than twice a year
Do you suffer from blood pressure problems ?
Do you suffer from a frequent cold/sinusitis?
Do nosebleeds run in the family ?
Have you had any injury to the nostrils after which the nose bleeding started ?
Have you got any investigation done ? (If yes, please mention the details of the reports in the 'more info column' at the end of the questionnaire)
Are you already a patient with Dr. Manoj's Homeopathy? If yes please state your Registration Number in the 'more symptoms' column.
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