Please read this first before filling out the form
We use advanced treatment in Homeopathy for patients by providing service from experienced homeopaths globally and state-of-the-art medical facilities.
All our efforts will be concentrated on selecting the best possible medicine for you. In order to do that, we depend on your co-operation. Homeopathic 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 makeup. 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 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 question that is of lesser importance.Even something that you may think is not connected with your trouble may be the most important factor in deciding the correct homeopathic 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 answers completely. Do not keep anything back. Remember,whatever you tell us will remain absolutely confidential. This questionnaire has 7 parts1. Description of your main complaint/complaints.2. About your past illnesses, vaccination details, and developmental history. It also includes details on the medical history of family members. Please take time to answer this part, preferably taking the help of your family members.3. Personal history that covers all your allergies and addictions, likes, dislikes, etc.4. Deals with the factors that affect your health. Please think carefully about each of the factorsmentioned 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. How you were as a child.7. Parts of the body affected.
Please Upload with this form:1. All your medical reports and opinions on your state of health from a physician.2. Recent copies of investigations done, e.g. C.B.C., ESR, U.S.G, X-ray plates, electrocardiograms, etc.3. Please mention if you have taken any homeopathic medicines. Brief us with the name of the medicine you have received along with a response to the same (if you are aware of it).
Past And Family history
Every disease, poisoning, drug, or accident leaves its mark and remains a weak point in the system, affecting us much more than we imagine.
Homeopathic treatment considers all these details of the past and thus removes all weak points. Your body is strengthened. It is therefore necessary for us to know about all the ailments you have suffered from in the past and the treatments you have taken.
In the list below, select the names of ALL major illnesses suffered