Online Consultation

Online Consultation Form

Please select your area of interest:
1. What is your age?

2. What is the skin complaint you are having?

3. How long are you having it does it recur, if yes how often?

4. What previous treatments were you on Specify with dates?

5. Is the skin condition diagnosed just clinically or with biopsy/tests Give details?

6. Any bad experience with any treatment type?

7. Were you following doctors instructions?

8. Do you have family history of the same skin disease?

9. Any other health problems ( Diabetes, Hypertension etc) and/or are you on any long term Medications?

10. Any other additional information you want to give us?

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