Eczema Evaluation Test | Dr Batra’s™

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Did you know?

About 10% of adults and
nearly 11% of children have eczema.

Take the eczema evaluation test now.

Tell us a bit about yourself

*You will receive your eczema evaluation test score on your contact details

AGE

0-18

18-25

26-35

36-45

46-55

55+

CHOOSE GENDER

Male

Female

QUESTION 1/10

Since when have you been suffering from the skin problem?

Less than 3 - 6 months

6 months - 2 years

More than 2 years

what are the symptoms you are experiencing?

Multiple selection

Itching

Redness

Flacking

Cracks

Dry Skin

Moist Discharges

Please select any option

Mark the areas affected by the skin lesion/White Patches?

Multiple selection

Chest

Abdomen

Face

Scalp

Hands / Legs

ANY OTHER

Please select any option

Grade of Itch

No Itch

Mild Itch

Severe Itch

Very Severe Itch Affects sleep

Are you getting new lesions / white patches?

YES

NO

Does anyone in the family suffer from similar lesion/White Patches?

YES

NO

Is your skin problem affecting your social life?

YES

NO

Are you undergoing any treatment?

Yes

No

What does the medicine comprise of?
Tick whereever relevant.

Multiple selection

Tablets

Creams and lotions

Cosmetic Corrective Treatment

Ayurvedic

Homeopathy

Light treatment

Any Other

Please select any option

On the scale of 1-5 rate your stress level

0

5

Please rate

Dear , Thank you for taking our Eczema evaluation test!