Name * Age in Years * Sex * ---FemaleMale Email * Please read each question, select yes/no. Provide any information you would like to share. Is there any weight gain? ---YesNo Puffiness of body features ---YesNo Loss of appetite ---YesNo Dry and coarse skin ---YesNo Too much/minimal/absent sweating ---YesNo Anemia ---YesNo Constipation ---YesNo Hoarseness of voice ---YesNo Generalized aches & pains ---YesNo Muscular cramps or stiffness ---YesNo Sluggishness/lethargy/sleepiness ---YesNo Heaviness in body/tiredness ---YesNo Premature aging symptoms like hair loss ---YesNo Cold intolerance ---YesNo Excessive intake of water ---YesNo Is there any dizziness ---YesNo Is there any giddiness ---YesNo Is there constantly headache ---YesNo Is there any heaviness or unwanted sounds from ears? ---YesNo Is there any cold and cough? ---YesNo Is there any cyst? ---YesNo Are there any black patches on face? ---YesNo Is there any abnormality in breathing? ---YesNo Reports of T3, T4 & TSH. ---YesNo Report attachment Only zip file allowed | Max size: 10 MB. Enter the characters