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Did you know?
70 million people across
the world have vitiligo.
Take the vitiligo evaluation test now.
Tell us a bit about yourself
*You will receive your vitiligo evaluation test score on your contact details
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AGE
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QUESTION
1
/
10
Is your skin developing any visible white patches?
YES
NO
Since when did you start noticing these marks?
3 Months
More than 6 months
More than a year
Please select any option
Where do you generally find these patches?
Multiple selection
Hands
Legs
Face
Others
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Does your skin experience any symptoms?
Multiple selection
Itching
Redness
None
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➜
Do you have any family history of vitiligo/
any other skin problem?
YES
NO
Do you suffer any of the below. Tick the relevant one
Multiple selection
Diabetes
Thyroid Disorder
Alopecia Areata
Any other Auto Immune Disorder
None
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Are you undergoing any treatment?
YES
NO
What does the medicine comprise of?
Tick wherever relevant.
Multiple selection
Tablets
Creams and lotions
Cosmetic corrective Treatment
Ayurvedic
Homeopathy
Light Treatment
Any other
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Is your skin problem affecting you emotionally?
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On the scale of 1-5 rate your stress level
0
5
Please rate
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Dear
, Thank you for taking our Vitiligo evaluation test!