In order to take a case for homeopathic prescribing, I ask for the following information from my

patients. You are requested to provide all possible information about the questions which seems
related to you only.

It consists of all those things about which you feel that they are not normal at any of the following
levels of your body:

o Mental Level: Things like forgetfulness, absentmindedness, lack of concentration, difficulty in

comprehension, etc.
o Emotional Level: Complaints like anxiety, depression, irritability, over-excitement, outbursts
of anger, stubbornness, jealousy, etc.
o Physical Level: Ailments pertaining to any part of your body from head to foot.

1. Are you afraid of bugs in your house (like ants, flies, spiders, cockroaches, etc)? What do you
do with them (kill them?)
2. Do you have an overwhelming fear of cats, dogs, snakes, lizards, wild or any other animal?
3. Any other fear, like of dark, of being alone, of future, of diseases, of death, etc Are you
comfortable at closed spaces, like washrooms, elevators, etc? (claustrophobia) Do you like to
do things in a hurry?
4. If you have to reach somewhere by 2 pm, when would you reach there?
5. While going there, would you have a feeling that you might get late?
6. Would you go back if you think that you are going to be late?
7. How do you feel at high places? (fear of heights) What do you like more, sweet or salty
things?
8. Are you comfortable in the Sun? If not, what do you feel?
9. When you are sad, what would you do? Would you like to be alone and cry or would you like
to spend time with your friends or go out for a walk?
10. When you are sad and someone sympathize with you, would you like the sympathy or would
you hate it?
11. How much sympathy do you have for others, especially for those who are in need?
12. Would you go out of the way to help them?
13. If you are thirsty, would you drink something warm or cold?
14. If cold, do you add ice in it?
15. In a thunderstorm, would you be scared, or watch it from window, or go outside to enjoy it?
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 16. How much do you like music and of what kind?
17. Do you feel the urge to dance?
18. How do you feel at the seashore?
19. Do you feel uncomfortable by looking at or going near to a large body of water, like sea?
20. If you are sitting in a closed room, would you like to open the window for fresh air?
21. Do you easily accept what others ask you to do? (some people cant say no to others) Do you
easily cry on emotional scenes in films or dramas? (emotional person)
22. How much cleanliness do you like in your home? Are you over-obsessed to keep things neat
and clean all the time?
23. Do you get tense easily?
24. What are the foods which you like the most?
25. And what foods do you hate eating? Do you feel heat more or cold?
26. What is your confidence level? (lack of confidence) Do you like chocolate?
27. What about milk? Do you like it?
28. Do you get angry on little things?
29. When in anger, what do you do? Do you speak it out or do you keep it inside?
30. Are you fond of traveling?
31. How much do you like to read?
32. How much do you like art? (artistic person)
33. Do you like to do things in a perfect way? (perfectionist) How much do you like nature?

It consists of an account of all the diseases/complaints/incidences you had/has since your childhood:

1. Major diseases like Malaria, Typhoid, Pneumonia, Chicken Pox, Measles, Tuberculosis, etc.

2. Minor complaints which used to occur at a certain interval of time, such as:

o Recurrent attacks of headache (the whole head or one-sided, if one-sided which

side?)
o Recurrent attacks of cough and cold
o Recurrent attacks of any kind of allergy
o Recurrent attacks of mouth ulcers (i.e., cankers or aphthae)
o Recurrent attacks of tonsillitis or throat infections with fever
o Recurrent attacks of stomach disorders (pain in the stomach or loose stools or
constipation)
o Recurrent attacks of skin ailments
o Or any other complaint for which you can say Recurrent attacks of . . .

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 3. Important incidences which had/has a deep impact on your life. For example:

Shock due to death of a loved one, financial loss in business, loss of job, etc.
Emotional suppression due to dictatorial behavior of parent(s), brother(s), sister(s), spouse,
etc.
Or any other incidence which resulted in extreme disturbance on your mental or
emotional level.

It consists of the history of diseases in your near family (blood relations). The diseases include any
one or more of the following:

Tuberculosis
Asthma
Diabetes
Cancer
Heart diseases
High Blood Pressure
High Blood Cholesterol
Rheumatism
Kidney Stones / Gallstones
Uterine Fibroids
Ovarian Cysts
Hemorrhoids (Piles) Warts or Moles etc.

The family includes the following relations:

Mother and Father; Sister(s) and Brother(s); Grandfather and Grandmother (both maternal and
paternal); Uncles and Aunts (both maternal and paternal)