PLEASE READ THIS FIRST BEFORE FILLING THIS
FORM
You have to get well. We
are here to select the best possible medicine for you .In
order to do that, we depend on your co-operation. HOMOEOPATHIC
MEDICINE IS MAINLY SELECTED ON THE SYMPTOMS YOU GIVE US. If we
are to make a successful prescription, we must know all the
details of your sickness. We must also understand all the
features that belong to you as an individual. This includes
your reactions to various factors, your past and family
history and your mental make up.
This information enables
us to selection the remedy that removes your sickness. The
medicine also makes you well as a whole person.
In order to find out all
about you, we shall be asking you many questions. Each one of
these questions has a definite meaning and significance for
us. There is not a single questions that is useless. Even
something that your may think is not connected with your
trouble, may be the most important factor in deciding the
correct homoeopathic medicine. That is why you must be free
and frank and give us the fullest possible information on each
point. Please read each question carefully, think and if
necessary, consult someone close to you and then answer
completely. Do not keep anything back. Remember, whatever you
tell us will remain absolutely confidential.
THIS QUESTIONNAIRE FORM HAS 8 PARTS :
- About your past illnesses and family
illnesses. Please take time to answer this part with the
help of your family members before coming to us.
- History of your present illness.
- About all the parts of your body.
- Deals with the factors that affect your
health.. Please think carefully about each of the factors
mentioned and write what specific effects they have on you.
- About your mental state and your
emotional nature. Please write in this part about your
situation in life and about all the things that are
bothering you. Be totally frank and open
- About your sleep and dreams.
- For children or you as a child.
- In this part you are given instructions
on how to report each of your complaints. Read the
instructions first. Then make a list of your complaints and
describe each of them according to the instructions.
Download Case Record From
Click on above link to download the case record form. You can then print it, fill it up and mail it to us.
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