Are you experiencing any pain in the region? WeeksMonthsYears
Is there any itching in the region? YesNotOccassionally
Is there any discharge from the stye?
YesNoOccassionally
Which part of the eye is the stye located in?
Upper lidLower lidBoth
Are you diabetic?
YesNoNot Sure
Do you wear glasses? YesNo
Have you got (any investigations done ? (If yes, then please mention the details of the reports in the ‘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.
Name:
Email Address:
Contact Number:
Location/City:
Gender:MaleFemale
Age:-Select-1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 Months234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798
More Symptoms:
