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Patient's History:

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We will help you to get rid of your disease as soon as possible. Please e-mail the answer of following questionnaire:


History Form
Name
Age
Sex
Mailing address
City
State
Zip/Postal code
Country
Phone
Fax
E-mail address
Query details
Total no.of motions in a day
Consistency of stool
Passage of blood
Passage of mucus
Urgency to go to toilet
Loss of energy
Loss of weight
Pain in abdomen
Any other complaint
Present medication
Investigation(Sigmoidoscopy/Colonoscopy
/Histopathology/Barium Enema)
Present Food
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