Write Your Case

Introduction and Instructions:

This questionnaire is developed to collect appropriate, accurate and detail information to deliver best and effective homeopathic treatment.

1. Copy and Paste this questionnaire, answer all the questions in as much detail as you can, but be careful about accuracy of your answers, and mail it to us.
2. It is better to write down your complaints from beginning to end; it means, please try to write down correct order of your complaints in which they appear.
3. Homeopathic prescriptions are based on “Totality of Symptoms”, it means we need all of your complaints which are present, may be you are not concerning about some subtle symptoms but we need every detail from you. If you are seeking prescription for ‘Headache’, please do not hide your complaints about bowel movements, in your view they may be a different things but for a Homeopath, all the present complaints are necessary.
4. If you are taking treatment for some other complaints, please write about it and write the drugs you are using, in detail.
5. We need details of every symptom, for example, if you have a headache, we need to know the character of pain, exact location, side, how it starts, time (if specific, as morning, evening, 10 AM etc.) when it starts, how it get worse (walking, in sun, summer etc.), how it get better (as lying, sleeping etc.), the other symptoms accompanied it (as nausea, vomiting, vertigo etc.). So always write in detail.
6. After writing carefully, send email on consulthomeopathy@gmail.com.
7. Be sure that you have paid the fees before sending an email for consultation. For more, click on "Consult Us" page.

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NAME:

AGE:

GENDER:

MARITAL STATUS:

NUMBER OF CHILDREN:

PROFESSION:

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Present Complaints

1. What is your main complaint? And since how long it is present? Can you suggest some factors which triggers, aggravate, start or help to relieve these symptoms?
2. Is this the first occurrence or can you write about some old episodes of this symptom?
3. Can you write down some associated symptoms which always or sometimes occur with your main complaints?
4. What are other physical sufferings do you have beside your main complaint, or any other disorder for which you are already taking some treatment?
5. Did you ever noted, at what time or part of day or in any particular season or weather, your complaints increased or decreased?
6. How your body reacts in, change of weather/ drafts of air/ change of temperature / extremes of temperature / exposure of sun or snow or cold?
7. What position do you like? Walking / Sitting / Standing / Lying / Kneeling / Turning / Rising / Running or anything else specific.
8. Is your complaints increase or decrease with seasons like Summer / Winters / Rains / Autumn / Fall.

 Mental and Emotional Preferences

1.      What are the greatest grief and joy, you have had in your life?

2.      Can you select some appropriate words about your nature from following:-

                Mild Temper / Irritable / Emotional / Angered / Easily offended / Melancholic / Crying / Hopeless / Talkative / Silent / Grief Stricken / Suicidal /  Murderous / Introvert / Extrovert / Company liking / Social / Likes Alone / Anxious /  Hurry/Fastidious / Slow / Lazy / Active / Forgetful / Fearful / Day Dreamer.

                        You can write as much detail as you want about your nature. Much will be better for us to analyze you.

3.      How you feel in middle of peoples, in crowd, in markets, at religious place?

4.      On what occasions you weep? How frequently or easily you weep? How do you feel after weeping?

5.      What are most important things / events / factors which make you worried? How do you cope with your worries?

6.      How do you feel when someone consoles you?

7.      On what occasions do you feel frightened or anxious? What make you fearful? Can you write something about your fears?

8.      When you feel revengeful? What make you jealous often?

9.      Do you forget something to do so easily? Are you forgetful? What you forget?

10.    Can you write about your sexual history? What are your preferences? Do you find any difficulty in your sexual performance?

Sleep and Food

1.      Can you explain about your sleep? And what dreams you see often? Please write them.

2.      Do you wake up easily? Frightened ? Do you face nightmares?

3.      Write about conditions of sleeplessness / disturbed sleep /  sleepy all the time.

4.      How you feel before / During / After meal?

5.      What about your appetite and thirst?

6.      What you like or dislike in food and drinks? What is your    taste? Which food disagree you? Anything in food or drinks which aggravate your complaints?

7.      Any kind of addictions if you have:- Alcohol /Beer / Smoking / Tobacco in other form/ Any drugs. Please write down.

8.      Can you write about your marked craving or aversion for any particular food or drinks?

9.      What food or drinks make you sick or increase your already present complaints?

10.    What is your taste? Sweet / Salty / Sour or something else?

11.    What happen when you eat Rich / Greasy / Spicy / Heavy food?

12.   What you like among Tea / Coffee / Juices / Wine / Beer or anything else?

Females

1.      At what age your periods started?

2.      What about frequency and regularity of periods?

3.      How do you feel before, during and after periods? Any associated complaints or symptoms with periods? Here you can write your mood swings too.

4.      What about the quantity, duration, odour, colour and consistency of periods?

5.      Is there anything happens with you before, during or after menses?

Others

1.      Have you already diagnosed for your complaints? Who diagnosed you? Attach your reports.

2.      Do you remember your past complaints, any disease or disorder for which you took treatment or admitted to hospital?

3.      Have you any skin problem in present or in past?

4.      Are you taking treatment for some other diseases?

5.      Is there any other sensations / numbness / tingling / pain in any part or as a whole?

6.      Please write about diseases or disorders which your parents and grandparents faced? 

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