Online Consultation

General Info
  • Name *
  • Age *
  • Gender *
  • Address
  • Country *
  • Landline No.
  • Mobile No.*
  • E-mail ID *
  • Fax No.
History of Present Disease
  • Onset:
    when did the problem start/ duration
  • Sites of involvement/ Areas affected
  • Symptoms:
    eg. itching/ pain /redness/ rashes
  • Progression of disease (Has the nature of symptoms changed?)
  • Provocative factors:
    Heat, cold, sunlight, exercise, drug ingestion
  • Any seasonal change or day /night variation
  • Treatment history & response to it
Past/Concomitant Medical History
  • Allergy (to drugs or anything else)
  • Any other problem like diabetes or hypertension
  • Medical history/ Any chronic medicinal intake
  • Habits (smoking, alcohol or drug abuse)
Family History
  • History of any similar illness in family members
  • History of any other significant problems e.g. asthma, rhinitis
Kindly attach a few close up photographs of your problem area and e-mail to: