- ICCONS,Shoranur, Palakkad (0466)2224869; 6238440945
- ICCONS, Pulayanarkotta,Trivandrum-11 (0471)2440232, 2447729
- icconssrr@gmail.com
- icconstvpm2018@gmail.com
Lifestyle Diseases
Name*
Age and Sex
District
Country and State
Pin/Zip Code
Telephone Number*
Email id*
Conduct Survey
Has anybody in your family is a diagnosed case of Lifestyle Diseases?
Diabetes: Have you (or your family members) experienced any of the following symptoms?(Excessive sweating, Excessive eating, Excessive thirst, Excessive urination, Excessive fatigue, Blurred vision, Edema in legs, Slow wound healing)
Hypertension: Have you (or your family members) experienced any of the following symptoms?(Weakness in the limbs, Dizziness, Balance problems, Blurred vision, Head tightness, Fainting, Headache, Persistently elevated blood pressure)
>Coronary heart disease: Have you (or your family members) experienced any of the following symptoms?(Chest pain, Chest tightness, Shortness of breath, Breathlessness while walking, Headache during physical exertion, Atherosclerosis)
Asthma: Have you (or your family members) experienced any of the following symptoms?(Shortness of breath, Wheezing, Frequent cough, Hypersensitivity (allergy to dust, pollen, insect, cold air, etc), Recurrent bronchitis)