Since how long have you had with this pimples? WeeksMonthsYears
Does your acne gets aggravated before, during or after your menstruation? BeforeDuringAfter Not applicable
Does it leave behind any scars? YesNo
Do you have a greasy face? YesNo
How are your bowel habits? NormalConstipatedDailyNot Daily
Do you have regular periods (if not please mention the details in the ‘more symptoms’ column at the end of the questionnaire) YesNoNot applicable
Have you got an ultrasound done (If yes, then please mention if you suffer with PCOD or any other conditions in the ‘more symptoms’ column at the end of the questionnaire) YesNoNot Sure
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. YesNoOccasionally
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