Since how long are you suffering from this problem? WeeksmonthsYears
Is there any itching at the pigmented area?
YesNoOccasionally
Is there a family history of similar pigmentation? YesNoNot Sure
Has the pigmentation been spreading over the years? YesNoNot Sure
Has the pigmented area been getting darker over the years? YesNoNot Sure
Does the pigmentation increase on exposure to sunlight? YesNoOccasionally
How is your menstrual cycle?( it is irregular, please mention the details in the ‘more symptoms’ column at the end of the questionnaire) RegularIrregular
Are you diabetic? YesNoNot Sure
Are you going to attach a photograph YesNo
Have you got an ultra sound done ( If yes, then please attach the report in ‘more symptoms’ column at the end of the questionnaire) YesNo
Are you already a patient with Dr. Manoj's Homeopathy? If yes then please give your Registration number in the ‘more symptoms’ column at the end of the questionnaire. YesNo
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Gender:MaleFemale
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