MEDICAL HISTORY FOR
Homeopathy is a holistic science based on concept of individualization.
In order to find out accurate homeopathic medicine, it is essential
to understand not only your complaints but also your entire
personality, your emotional state, your stresses, your relationships
as well as effects, likes and dislikes pertaining to food climate
Incomplete information will make correct choice difficult. You
are therefore requested to supply the information without keeping
anything back as irrelevant or of little importance. The history
that you provide becomes basis for further inquiry. Hence, we
earnestly request for your full co-operation. All information
supplied, of course, will be strictly confidential.
This information will help us in rendering you the best possible service.
Please supply the following information as standard routine:
Name in full, Address, Date of Birth, Sex:
Status ( Single / Married / Widow-ed since / Divorcee since):
Religion /Community/Sect, Vegetarian / Non-vegetarian / Eggs,
Tobacco, chewing/smoking, Tea, Coffee, Beer, Whisky and liquors
(please state the quantity consumed daily)
Educational career and qualifications. Occupation, with a full
address and tel. no.
Your daily routine from getting up in the morning to retiring
at night. Include in this your dietary schedule furnishing full
details in respect of the quantities consumed.
Describe what bothers you most.
Describe in details your entire experience about the complaints
which trouble you the most. Please describe when exactly these
complaints started. Also, describe the circumstances under which
these complaints began and mention the factors that increase
and decrease the discomfort.
Describe all complaints which had troubled you in the past
Each should be described fully as suggested above for the ‘CHIEF
Give a full account of the following:
(1) Physical description of self like weight, height, physique
(2) Share your experience about significant events in your life
and their impact on you.
Describe the nature and responsibilities
of your work (current and previous). Describe the difficulties
you experience in the place of work and the level of job satisfaction.
Describe financial responsibilities and strains ( present as
well as in the past).
Give a clear cut picture of your
relationship with your family members and associates.
(3) Reactions to surroundings.
(a) Food desires and aversions, foods that do not suit etc.
(b) General environment: Describe which weather suits you the
most. Also describe
about type of temperature, bath,
(c) Sleep and dreams
(d) Sex (inclusive of menstrual and obstetric history).
Give a resume of the various illnesses you had and to what extent
these have any bearing on present troubles.
Data concerning the parents, brothers and sisters. State details concerning the health of wife and children. Include in your list those who have died stating the age of death, the year and cause of the same.
Include here any items which have not been included above.
1. Medical Report and opinion on your state of health from physician.
2. Copies of Reports of investigations done.
3. X-ray plates, Electrocardiograms, etc.