This questionnaire is designed to help us better understand your concerns and identify the most appropriate treatments for you. It may also assist you in reflecting on your symptoms and how they impact your quality of life.

Please answer as many questions as you can. If any feel difficult to answer, you may leave them blank, and we can discuss them during your consultation if needed.

All information you provide will be kept strictly confidential in accordance with Data Protection legislation. If any questions are unclear—particularly those regarding previous treatments—or if certain sections do not apply to you, feel free to skip them.

If you have any difficulties filling out this form or need assistance, please reach out to Dr. Abhishek Mangeshikar’s team:

📱 WhatsApp: https://wa.me/+919820550483
(The above number receives a high volume of inbound calls and enquiries. So in case the line is not reachable, kindly WhatsApp so that someone from our team can get back to you at the earliest.)

📧 Email: support@endometriosis-india.com

Thank you for your time—we look forward to assisting you.