PLEASE READ THIS FIRST BEFORE FILLING THIS FORM

In order to select the possible medicine for you , we depend on your co-operation.

HOMOEOPATHIC MEDICINE IS MAINLY SELECTED ON THE SYMPTOMS YOU GIVE US.
To make a successful prescription, You have to give all the details of your sickness. Everybody is different in this world i.e. not alike externally as well as internally. Individually we all are different so you have to mention 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 select the remedy that removes your sickness. The medicine also makes you well as a whole person.

In order to find 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 question that is useless. Even something that you 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 HAS 9 PARTS :

• 1. About your present illness in detail.
• 2. About your past illnesses. Please take time to answer this part with the help of your family members before coming to us.
• 3. About all the parts of your body.
• 4. 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.
• 5. 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.
• 6. About your sleep and dreams.
• 7. About your childhood, upbringing, deprivations or how you were as a child.
• 8. 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.
• 9. Photos depicting Front Face , Side Face , Video showing you laughing , moving , talking to someone , may be your mother ,spouse ,friend or some old videos of any function at home or outside.

***The appointment will be valid only after you complete all form. If you have left your form in between, you can login to your account and complete your form.