Have you ever been treated by a Dermatologist?

If yes, please provide details

Diagnosis

Treatment given

Medical history

H/o Diabetes, High blood pressure, Heart disease

If yes, Please provide details of medication

Do you smoke?

Do you consume alcohol?

Are you Pregnant?

Are you lactating?

Any history of PCOD?

Are you on Aspirin/Evion/Vit E

Any drug allergies

Comments

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