Pre-appointment questionnaire

Welcome to Dumfries and Galloway Homeopathy
Charitable clinics run by Homeopathy UK

The clinic offers up to five homeopathic consultations including the initial appointment.

Consultations are provided free of charge; however you are encouraged to make a donation for your consultation with the aim of helping the clinic to become self-funding and of value to the community long into the future. Details of how to make a donation will be provided when you book your follow up appointment or you can donate via the Donate button on our website. We are extremely grateful for any donations, no matter how small.

We aim to provide all our patients with the best possible service and to achieve this we need your cooperation. The demand for appointments in our clinic is extremely high as the clinic is run on a charitable basis. Non-attendance and cancellations at short notice may mean another patient who wants to attend the clinic is unable to due to limited availability. If you are unable to keep your appointment, please make every effort to cancel it well in advance, so that it may be offered to someone else. Please contact the clinic by 1pm on the Tuesday before your appointment at the latest if you need to cancel. Failure to attend you appointment on the day, repeated cancellations or rearrangements may result in your removal from our clinic list.

The initial prescription is also free of charge. For subsequent consultations you are required to meet the cost of the prescription which generally ranges from £7 to £15, depending on what your practitioner has prescribed for you. The pharmacy preparing the remedy will typically call you for your payment details a day or two after your consultation.

Attached is a pre-assessment questionnaire that needs to be completed prior to your initial appointment.

The clinic is attempting to run a paperless system. If you are able to email this completed questionnaire back to the clinic the week before the appointment, we would be very grateful. Please email to DumfriesGallowayapp@homeopathy-uk.org. If you are not able to return the questionnaire by email then please have any medication, supplements or remedies you take with you at your consultation.

Please ensure you include your full address and postcode so that prescriptions can be sent quickly and efficiently to your door.

If you have any questions prior to your appointment please contact the clinic on:

0203 640 5903, option 1, option 1.

Thank you and we look forward to seeing you soon.
Pre-appointment questionnaire

To be completed before or at the patient’s current visit
Patient Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Telephone*
Please enter a valid phone number.
Email*
example@example.com
Date of birth*

DayMonthYear
Age*
Appointment Date*

MonthDayYear
Why did you come to the clinic today?*
Please note your current health complaints and rank them in order (1 being the most important)?*

Do you have one of the following conditions:*

	No	Yes	N/A	Comment
High Cholesterol Problems with medication(s)?
Diabetes Problems with medication(s)? Most recent home glucose readings:
High Blood Pressure Problems with medication(s)? Most recent home blood pressure readings:
Depression Problems with medication(s)? Any suicidal thoughts?

Have you been to the Accident & Emergency service, hospital or any other clinical provider in the past year?*

Alcohol*

	Never	Monthly or less	2-4 times per month	2-3 times per week	4 or more times per week
How often do you have a drink containing alcohol?

	0	1 or 2	3 or 4	5 or 6	7 to 9	10 or more
How many standard drinks containing alcohol do you have on a typical day?

	Never	Less than monthly	Monthly	Weekly	Daily or almost daily
How often do you have six or more drinks on one occasion?

Caffeine*

	No	Yes: How often?	How much?
Do you consume any caffeine?

Exercise*

	No	Yes: How often?	How long?
Do you exercise?

Smoking*

	No	Yes: How often?	How much?
Do you smoke?

Birth control*

	No	Yes: What method?
Do you use any form of birth control?

Medication adherence*

	No	Yes: Describe.
Do you experience any difficulties or issues with your medication?

What medicines are you taking and for what conditions?*
What is your family medical history?*
Do you have any allergies?*
Have you recently developed any reactions to any of your medications? If yes, please describe below.*
Have you had any health problems after which you have never been totally well since? Which ones?*
How would you describe yourself? E.g. tired, go-getter, happy, withdrawn, confident, etc. Use as many adjectives as you would like.*
Are you experiencing any of the following?

Abdominal painAnxietyBlood in stoolsBloody urineBreast massBruisingChanging moleChest painConstipationCoughDiarrhoeaDouble visionEar painEnlarged lymph nodesExcessive thirstExtreme fatigueFallingFeverFrequent urinationHay feverHeadacheHeart palpitationsHeat/cold intoleranceImpotenceIrregular mensesJoint painMuscle weaknessNauseaNumbnessPainful urinationRunny noseShortness of breathSore throatSudden vision lossSuicidal thoughtsUnusual bleedingVomitingWeaknessWeight lossWheezing
Do you have any other concerns? *
FAQs

When is the clinic offered?

10.00am-13.00pm fortnightly at CatStrand, High Street, New Galloway, DG7 3RN.

What is the difference between an initial consultation and a follow-up?

An initial consultation is the first appointment with the homeopath. You will be allocated 60 mins of time. There will be a considerable amount of questions to get the best information about you as a person as well as the health issue you have come in for treatment. A follow-up will take 30 minutes and will fine-tune on the information gained in the initial consultation and changes in your health and well- being since the last appointment.

What is the cost of an appointment?

Consultations are free but patients are encouraged to make a donation to help secure the long-term future of the clinic.

How do I book my appointment?

To book appointments please follow this link https://homeopathy-uk.org/book-an-appointment-dumfries-and-galloway/

Or call 0203 640 5903, option 1, option 1.

Who is providing care at the clinic?

Elaine Hamilton is the homeopath running the clinic and has extensive experience in homeopathy.

How is the clinic charitable?

The clinic is meant to enable access to homeopathy for anyone, given NHS services have been stripped bare and everyone should have the ability to benefit from homeopathy. The usual cost of an initial consultation is between £75-£200 and a follow-up £45- £150. The donation we ask patients to make is to ensure people value the service and ideally allow us to recoup costs for the room rented to provide the clinic. The clinic is run and funded by Homeopathy UK (registered charity 235900) and co-funded by SHRET.

What can be treated with homeopathy?

Many people can attest to positive results using it to assist in the relief of migraines, chronic pain, anxiety, depression, skin problems, ear infections, recurrent health issues, sleeplessness, hayfever, sport injuries and many other issues. See our conditions directory

Can children benefit from homeopathy?

Yes, children can benefit from homeopathy and given how homeopathic medicines are produced it is very safe. Pregnant women can also take homeopathic medicines without issue to help with many pregnancy related issues, such as morning sickness, cramps, etc.

Is there evidence homeopathy works?

Yes there is certainly evidence. To find out more go to Homeopathy Research Institute’s website https://www.hri-research.org

We recommend that individuals seek advice from their healthcare practitioner on their health conditions before seeking homeopathic treatment.

How will I get my medicine?

Your first remedy is free of charge and will be sent from a homeopathic pharmacy called Freemans.

After the follow up consultation the homeopath will prescribe a homeopathic medicine. It will be sent by post to you. If usually arrives within two days. You will be invoiced for the medicine and will need to pay for the prescription. The amount is usually between £7- £18

What if I have questions?

The information in the post-appointment pack provides loads of useful information about taking your remedy, how to contact the homeopaths, what do to in an emergency, etc.

******************************
POST APPOINTMENT INFORMATION SHEET

Taking your homeopathic medicine:
- Read the instructions carefully.
- Take nothing by mouth 30-60 minutes before and after taking your homeopathic medicine. Your mouth should be free of any taste from food, drinks, toothpaste, breath mints, mouthwash, etc
- A dose of homeopathic remedy is usually 1-2 tablets or pills, 1 powder, 1-2 drops or liquid potency or about 100 of the tiny poppy seed granules (for these it does not have to be precise). The dosage for you should be clearly indicated on the label,
- Do not touch the remedy by hand; dispense them from the bottle into the cap and then from the cap into your mouth or under your tongue.
- Only take the exact number of doses of your remedy that your practitioner has prescribed. This will be indicated on the label and if anything is unclear contact the pharmacy before taking any of the remedy.
- Protect the medicine -- do not expose it to moisture, direct sunlight, or heat over 30 degrees (for example, in your car during summer!). Store the remedy in a cool, dry place away from bright light and strong odours such as essential oils or cleaning solutions.
- Discard any contaminated remedy. If some gets spilled, throw it away; do not return it to the bottle. Keep remedies in the original container in which they were dispensed and not transfer to any other container.
- Don’t be over stimulated with caffeine. Coffee produces its own symptoms which can be confusing.
- Use toothpaste that is either non-mint or at least not strongly mint flavored. (Leaving the cap off the toothpaste tube will help reduce the strong flavoring).
What to expect:
- The remedy is only a catalyst, it’s a “starter”; your immune system takes it from there!
- The first thing to change will be your mental/emotional state (and you should feel like you have more energy and a sense of calm; in fact, you might fall asleep, or feel like you want to fall asleep; children, babies, usually do fall asleep after a remedy, it’s very common and we generally count it as a sign that the remedy chosen was correct)
- Next will be the physical changes and they will be dealt with in a certain order, not all at once and, when an issue is resolving, it moves out, like the ripples in a pond, rather than simply disappearing! Mental disturbances, for example, may disappear and be replaced by a fever or a “cold” (don’t run and get antibiotics or paracetamol/ibuprofen etc. because you will just suppress your case back to the mental plane); so, it’s really important to be able to properly judge just what a new “complaint” means after a remedy.
- If you notice no improvement or change this will be discussed at your follow up appointment.
When to contact your homeopathic practitioner:
- you notice an aggravation of your symptoms that is not tolerable and does not settle within a few days
- if new symptoms appear that you are unable to tolerate until your next appointment
- old symptoms return that are not short lived or become intolerable and you do not feel able to wait until your next appointment
Useful contacts for:
- Questions about your medicine, contact a homeopathic pharmacy and tell them you are a patient of the clinic.
- Freeman’s Homeopathic Pharmacy:
  0141 644 1165 or pharmacy@freemans.scot
- Helios Homeopathic Pharmacy:
  01892 537254 or pharmacy@helios.co.uk
- Reaching Ms Hamilton (non-urgent) – email DumfriesGallowayclinic@homeopathy-uk.org
- Booking another appointment at the Dumfries and Galloway Clinic –
  https://homeopathy-uk.org/book-an-appointment-dumfries-and-galloway/
  Emergency homeopathic advice – Homeopathy Helpline 09065 343404 (costs £1.53 per minute)
- Health query non-urgent – dial 111 for 24 hour NHS advice or contact your registered GP Practice
- Health emergency – dial 999
Homeopathy UK takes your privacy very seriously. It is our duty to protect the personal data we hold. We will never pass on personal data to third parties without permission and we have never sold information to any commercial organisations. You can read our Privacy Policy at https://homeopathy-uk.org/privacy-statement

We use SurveyMonkey for our Feedback Form automation platform. By ticking the box you acknowledge that the information you provide will be transferred to Survey Monkey for processing in accordance with their Privacy Policy.

You can change how you hear from us at any time, email us at info@homeopathy-uk.org or phone us 020 3640 5903.
Appointments | 0203 640 5903 option 1| DumfriesGallowayapp@homeopathy-uk.org

Dumfries and Galloway Homeopathy is a charitable clinic run by Homeopathy UK in partnership with SHRET; a registered charity (number 235900) Registered Charity No: SCO49515– Scotland.| https://homeopathy-uk.org | 020 3640 5903
Should be Empty: