Assessment Form

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1. Do you have trouble breathing or coughing when you walk or exert yourself a little?

2. Does weather change affect your allergic symptoms?


3. Do you wake up at night due to cough or breathlessness?

4. Do you use an inhaler?

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5. Is there a wheezing sound in your chest?

6. Do your symptoms ever interfere with exercise and daily activities?

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7. Do you have breathing difficulty or cough when you climb up?

8. Is mold or mildew(damp walls), a problem at your home?

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9. Does your nose get itchy or watering in morning?

10. Do you live near any areas of heavy smog or air pollution?

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11. Have you exposed to any chemical, organic dust, etc. at home or work?

12. Does any member of your family have a history of allergy?

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13. Do you sneeze a lot when you wake up in morning?

14. Do your eyes get itchy or watering in morning?

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15. Have you ever smoked?

16. Does anyone in your home smoke?

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Name: {{name}}
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Your Point Score is: {{points}}
Analyse your point score with following results

SEVERE: [95-144]
You might be at Risk of suffering from ALLERGIES & ASTHMA. Consult doctor at Homeoclinic with following investigations- Lung Function Test CBC Serum lgE

MODERATE: [50-94]

MILD: [0-49]
You might be at risk of Dust allergies. You might be suffering from varied allergies due to weaker immunity. The symptoms indicate that you are probably suffering from allergies. These allergies can go as mild as a cough to as chronic as asthma. Homeopathy can help you to overcome your allergies and treat you completely and naturally. Get in touch with us today and find a way to your holistic recovery