Since how long are you suffering with this problem ?
WeeksMonthsYears
Which shoulder has been affected ?
RightLeftBoth
Is there any pain in the affected shoulder ?
YesNoOccasionally
Is there any stiffness in the affected shoulder ?
Is the movement of your shoulder restricted ?
Do you feel any pain when you lay on the affected shoulder ?
Are you diabetic ?
YesNoNot Sure
Have you taken any local injections for relief ?
YesNo
Have you done any physiotherapy ?
Have you got any investigations done like an x-ray of the shoulder? (If yes, then please mention the details of the results in the 'more symptoms' column at the end of the questionnaire)
Are you already a patient with Dr. Manoj's Homeopathy? If yes, then please state your Registration Number in the 'more symptoms' column. YesNo
Name:
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Gender:MaleFemale
Age:-Select-1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 Months234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798
More Symptoms:
