First Name:


Last Name:


E-mail Address:


Street Address:


City, State, and Zip:
  

Country:


Home Phone:


Work Phone:


Sex:
 Male
 Female

Age:


When did you notice the onset of Hyperhidrosis?


Is there a family history of Hyperhidrosis?
 Yes
 No

At what age did you discover that there was a name for this syndrome?


At what age did you seek remedies for Hyperhidrosis?


At what age did you see a physician?


What did the physician recommend?


How did you find out about Hyperhidrosis?


How did you find out about me?


What treatments have you tried?
 Drysol
 Drionics
 Biofeedback
 Medications
 Accupuncture
 Hypnotherapy
 Aromatherapy
 Meditation
 Psychotherapy

Other treatments:


How effective were these types of therapy?


How has Hyperhidrosis affected you?
Please be as complete as possible. Each patient has their own unique experience that is not conveyed well in the literature. Most people who don't have the syndrome do not understand the patient with the syndrome.


Questions or Comments: