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PCOD Survey Form

Name

Age Group

Mobile Number

State:

District

Occupation

Have You been Diagnosed?

Undergone treatment?

Hospital Name

Number of Sessions

At What Age you have diagnosed with Pcod?

Reason for PCOD

Genetics

Stress

Unhealthy diet

Minimal exercise routine

Hormonal imbalance

Don’t know

Symptoms

Irregular periods

Excessive hair growth (hirsutism)

Weight gain/loss

Acne or oily skin

Hair thinning or hair loss

Dark patches on the skin

Difficulty in conceiving

If not cured, what treatment are you currently following?

Medication

Lifestyle changes

Home remedies

Ayurvedic/Homeopathy

No treatment yet

If cured or symptoms improved, what helped the most?

Medication (e.g., hormonal pills)

Lifestyle changes (diet & exercise)

Ayurvedic or homeopathic treatment

Stress management techniques

Interested in consulting a doctor?

Would you be part of volunteering?

A PROJECT OF KALAM DREAM LABS

WHO WE ARE

We are a registered Non- Profit Organization under the Andhra Pradesh Society Act, 2001 bearing register No 101/2021 and came into force for safeguarding the sanctity of Vizag and making it a better place to live in
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Flat No: 401, Vinayagar Heights
Sampath Vinayaka Temple Road
Visakhapatnam – 530003, A.P. (INDIA)
7337335557

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