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Homeopathic online Case Taking

First Name

Last Name

DOB

Country

Marital Status

Occupation

Sex

Diet

Previous 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 Measles

Family History

Anaemia

Insanity

Leprosy

Urticaria

Paralysis

Kidney disease

Cancer

Rheumatism

Epilepsy / Fits

Eczema

Hypertension

Liver disease

Diabetes

T. B. / Pleurisy

Bleeding tendency

Asthma

Heart trouble

How 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

Bread

Fats

Milk

Mud / Chalk

Cabbage

Warm Food / Drink

Cold Food / Drink

Salt Extra

Sour Food

Butter

Coffee

Spicy Food

Onions

Cold Food / Drink

In 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 Input

If 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/ Emotiona

Your Habits

Smoking

Snuff

Chewing Tobacco

Tea

Sleeping Pills

Laxatives / Purgatives

Any other

MAIN 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 & Urine

Any 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 – Chill

How 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, urinous

Chest – Heat – Cold – Cough

Do 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?

How 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?

Wanted erection? Unwanted erection? Weak erection? Failing erection? Describe.

Any other trouble in sex? Describe in details.

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