Please answer the following questions. Please answer very correctly and with responsibility.

1.  *

2. Name: Age: (Above 18, or below 18). Postal Address for sending Remedies: *

3. Is your Asthma a Cough, or Wheezing, or Both? Since about how many years are you suffering from it? *

4. Do your attacks NOW start at any particular time? If so, please mention the time or times when they start (please specify the time, such as 3 A.M. or 4 P.M., or other). THIS IS IMPORTANT. How long does the coughing last. *

5. If you have any questions, or comments, please enter them here, or email me to firozm20@hotmail.com: