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Gender MaleFemaleBetter not to say
Diet VegNon-veg
Smoking NeverOccasionalyFrequently
Drinking NeverOccasionalyFrequently
Ailmenets Hair LossPimples / AcneEczemaVitiligo / leucodermaAsthmaAddison’s DiseaseAllergic RhinitisAlopecia AreataAnkylosing SpondylitisBronchitisCervical SpondylitisConstipationDepressionGastritisHemorrhoidsHyperthyroidismHypothyroidismIrritable Bowel SyndromeLichen PlanusMigraineObesityOsteoarthritisPremenstrual SyndromePsoriasisRheumatoid ArthritisSinusitisTonsillitisUrticariaWartsAny Other
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