All fields are mandatory.

For patients under 18 years of age, this form must be completed by the parent/guardian.

(1 = Not a problem)
(10 = Severe problem)
  • Please check the statements below that describe your experiences with underarm sweat.
  • Evaluate your condition on a scale from 1 to 10 (10 = bothers me a lot, 1 = doesn’t bother me much).

    PERSONAL INFORMATION  

    Fields marked with an asterisk (*) should be completed to send the form.

    According to medical confidentiality, we are committed to maintaining the privacy of medical and personal information entrusted to us and these data will not be published or otherwise used apart from the purposes of this assessment.