Since when have you been suffering from leucorrhoea? DaysWeeksMonthsYears
Do you experience any back pain? YesNoOccasionally
Does the discharge have an Offensive smell? YesNoOccasionally
Does the discharge occur before periods? YesNo
Does the discharge occur after periods? YesNo
What colour is the discharge? WhiteYellowishBrownishNot sure
Do your private parts itch? YesNoOccasionally
Is there a back pain during the discharge? YesNoOccasionally
Is there any rash out side the (private area) YesNoOccasionally
Have you got any investigation 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 patient with Dr.Manoj's Homeopathy? If yes please stage your Registration Number in the more symptoms column. YesNo
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