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Symptom Assessment
This helps Dr. Babayan understand your case in clinical detail before your consultation.
Your Details
Full Name
*
Email Address
*
Phone Number / WhatsApp
*
Date of Birth
*
Your Condition
Which area(s) are affected?
*
Which area(s) are affected?
How long have you been experiencing this?
*
How long have you been experiencing this?
A
Less than 3 months
B
3-12 months
C
1-3 years
D
3-5 years
E
5-10 years
F
More than 10 years
Has the pain been getting worse, better, or stable?
*
Has the pain been getting worse, better, or stable?
A
Getting worse
B
Getting better
C
Stable
D
Comes and goes
Have you been diagnosed by a doctor? (optional)
*
Your Pain
Where exactly is the pain located?
*
Does the pain radiate to other areas?
*
Does the pain radiate to other areas?
A
Yes
B
No
Do you experience numbness or tingling?
*
Do you experience numbness or tingling?
A
Yes
B
No
What is your pain level on a typical day
*
What is your pain level on a typical day
0
1
2
3
4
5
6
7
8
9
10
What triggers or worsens the pain?
*
What relieves the pain?
*
Daily Impact
How does this affect your daily life?
*
How does this affect your daily life?
What activities have you had to give up or modify? (optional)
*
Treatment History
What treatments have you tried?
*
What treatments have you tried?
Are you currently taking any medications?
*
Medical Safety
Do you have any allergies?
*
Anything else you'd like Dr. Babayan to know? (optional)
*
Submit Assessment