Homeopathic online Case TakingHomeopathic online Case TakingFirst NameLast NameEmailDOBCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweMarital StatusMarital StatusSingleMarriedDivorcedWidowOccupation SexGenderMaleFemaleDietVegetarianNon-VegetarianPrevious diseases & drugs used Typhoid Worms Measles Small-pox Malaria Miscarriage Sickness during Pregnancy etc. Rickets Any venereal disease like Syphillis Gonorrhoea etc. Nephritis (Kidney or urine trouble) Diabetes etc. Prostate trouble Appendix operation Uterus operation Phimosis operation Diptheria Recurrent infections Eosinophilia Pneumonia T. B. Numbness Convulsions Polio Any major accident or injury to body or head Cholera Diarrhoea German MeaslesFamily History Anaemia Insanity Leprosy Urticaria Paralysis Kidney disease Cancer Rheumatism Epilepsy / Fits Eczema Hypertension Liver disease Diabetes T. B. / Pleurisy Bleeding tendency Asthma Heart troubleHow is your appetite?When are you most hungry?How fast do you eat?How much thirst do you have?What happens if you have to remain hungry for long?Do you feel any change in your taste and feeling in your mouth?Bitter Food- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesBread- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesFats- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesMilk- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesMud / Chalk- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesCabbage- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesWarm Food / Drink- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesCold Food / Drink- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesSalt Extra- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesSour Food- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesButter- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesCoffee- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesSpicy Food- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesOnions- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesCold Food / Drink- Select -LikeDislikeStrongly LikeStrongly DislikeDisagreesStrongly DisagreesIn homeopathy consideration of mental symptoms is the most important aspect of homeopathic case taking. Mental symptoms consist of emotional, intellectual and subconscious state of mind. They unfold the true image of the disease. We may get many mental symptoms from a patient but assigning them peculiar, characteristic in the case and interpreting them correctly is a big task.Are you anxious? About which matters?Are you fearful of anything such as animals, people, being alone, darkness, death, disease, robbers, sudden noises, thunder, of the future, of something unknown, high places, etc.?Are you doubtful or suspicious? Of what?What are you jealous about? Of whom? From what symptoms do you suffer when jealousy?In which matter are you impatient? Hurried?How long do you remember hurts caused to you by others?How much revengeful are you?Depress, Brooding, etc.?Do you ever become suicidal? When?If so in what manner do you contemplate to end your life?Even then, are you afraid of dying?When are you cheerful?Are you sexual-minded?Any unwanted thoughts any time? What are they?Have you any imaginary sensations or fears?Do you hear voices, or that you are called, or anything else in this line keeps on occurring in your mind unduly?How is your memory?For what is it poor? E.g. names, places, faces, what you have read, etc.Do you weep easily? What makes you weep? How do you feel after weeping?How do you feel if someone offers sympathy and consolation?Are you easily irritated?What makes you angry?What bodily symptoms do you develop when angry? e.g. trembling, sweating etc.Do you like company? Or like to remain alone?How seriously are you affected by disorder and uncleanliness in your surrounding?What are the greatest griefs that you have gone through in your life?What are the greatest joys that you have had in life?What activities you deeply like?Are there any matters which you deeply dislike?In your opinion, which aspects of your mind and moods are not agreeable to you? In spite of your awareness and maturity, are you unable to change these aspects?Give a clear cut picture of your situation in life and your relationship with each of your family members, friends and associates in work.How does the future look to you?Text InputIf asked for 3 desires or wishes in life, what will you ask for?What are you proud of? Does your pride get easily hurt?Select if you as child had any of the following qualities Obstinacy Temper Tantrums Disobedience Aggression Hyperactivity Destructiveness Courage Possessiveness Competition - winning spirit Sibling jealousy Unusual desires Boasting Stealing Telling lies Unusual fears Shyness Unusual attachments Biting nails Thumb sucking Picking and playing with mother's body parts Picking and playing with shawls, handkerchieves Picking and playing with anything else Religious Dullness of memory Slowness Laziness/ Indolence Sensitive/ EmotionaYour Habits Smoking Snuff Chewing Tobacco Tea Sleeping Pills Laxatives / Purgatives Any otherMAIN COMPLAINTS AND OTHER ASSOCIATED TROUBLES : (AND DETAILED HISTORY OF THE PRESENT ILLNESS, THE ONSET AND COURSE WITH DATES)ORIGIN OF CAUSE : Can you trace the origin of the present illness to any particular circumstance, accident, illness, incident or mental upset? (e.g. Shock, worry, errors in diet, overexertion, overexposure to cold, heat etc.)?Urination & UrineAny problem about urine?Any strong smell? Like what?Do you have any trouble before, during and after passing urine? After passing urine, sometimes 2-3 dropping of urine most of the time but not always?Any difficulty about the flow? Slow to start, interrupted, feeble, dribbling etc.?Any involuntarily urination? When?Sweat / Perspiration - Fever - ChillHow much do you sweat?Where and on what part do you sweat most?Do you perspire on the palms or soles?Is the sweat warm, cold, clammy, sticky, musty, greasy, stiffens the linen etc.?What is the smell like? E.g. foul, pungent, sour, urinousChest - Heat - Cold - CoughDo you catch cold often? If so, how?Is there any trouble with your CHEST or HEART? Is there any trouble with your voice or speech?Describe the symptoms, nature of discharge etc.Is there any difficulty in breathing?Do you have cough? Is it more at any particular time?Sexual Sphere (General)How is your sexual desire?- Select -LowMediumHighVery HighHow do you feel after sexual intercourse?Any particular feeling or symptoms appear before, during or after sexual intercourse?Do you suffer from any sexual disturbance?Any habit like (masturbation etc.) in past as well as present? How often?Any homosexual inclination?Did you suffer from any sexually transmitted disease? Syphilis? Gonorrhoea? Herpes? HIV?What is the method you use for family planning (contraception)?Any difficulty in erection? For mens onlyWanted erection? Unwanted erection? Weak erection? Failing erection? Describe.Any other trouble in sex? Describe in details.I consent to have this website store my submitted information so they can respond to my inquirySubmit
