If you have already read articles and also aware of how the homeopathic approach
works in the treatment of health issues, please
complete the following questionnaire in detail. We will get back to you with Fee details
and plan of treatment.
Name:
Age:
Profession:
Address:
City, State:
Country:
Email:
Telephone:
Present
Problems
Please describe your present problems, when they started, how and when
they become aggravated etc...
State of mind
Please write about your mental state (example: your feelings of anger, love, hate, depression, anxiety, fear, etc...)
General Information
Please write about your appetite, thirst, cravings, aversions, flatulence, sleep, dreams, sweating, etc...
Physician findings and lab Reports
Please write about physician's findings and lab reports about your health
issues.
Family History
Health history of your parents and grandparents (blood pressure, heart problems,
allergies, eczema, skin problems, asthma, migraines, any other neurological
disorders, cancers, mental disorders)
