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Patient Form - homeo.remedies



Patient Form
Here is a list someone posted here. Please complete this fully.



1. Describe your main suffering?

2. What physical symptoms do you have in your body?

3. What mental feelings do you have associated with your physical?

4. What exactly do you feel when you are at your worst?

5. When did it all start? Can you connect it to any past event or disease?

6. Which time of the day you are worst?

7. What are the things which aggravate your suffering and which are those which ameliorate the same?

8. Do your think your sufferings have relation to any external stimuli (like, change of place) or any internal biological changes in the body, like, menses (in females)?

10. When do you feel better, during hot weather or cold weather, humid or dry weather?

11. Describe your general mental set up? Are you Moody, Arrogant, Mild, Agreeable Changeable, Nervous, Suspicious, Easily offended, Quiet, Arguing, Irritating, Lazy etc.


- How do you feel before or during a thunderstorm?

- Do you like being consoled during tough times?

- Are you sensitive to external stimuli like smell, noise, light etc?

- Do you have any typical habit or gesture like nail biting, causeless
weeping, talking to one self etc?

- How do you feel about your friends, family, your children and especially your husband / wife?

12. What are your fears and do you dream of any situation repeatedly?

13. What do you crave for in food items and what are your aversions?

14. How is your thirst: Less, Normal or Excessive?

15. How if your hunger: Less, Normal or Excessive?

16. Is there any kind of food which your body can’t stand?

17. Is your sweat normal or less or more? Where does it sweat more: Head, Trunk or Limbs?

18. How is your bowel movement and stool type?

19. How well do you sleep? Do you have a particular posture of sleeping?

20. Do you think you are able to satisfy your sexual desires in general?

21. What peculiar or strange sensation do you have in any part of your body at times? Do you sometimes feel ‘ as if…..’ in some part of the body?

22. What medications have been taken earlier by you to treat the diseases and do you have any particular symptom surfacing after the medication?

23. What major diseases are running in your family?

24. Describe, how do you look like? Describe your overall appearance.
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