This questionnaire is specifically designed to enable appropriate and effective homeopathic treatment. While some of the questions may seem irrelevant to your immediate health concerns, however they are important to determine your overall health picture.
Please answer the questions in as much detail as possible and bring the completed form with you on your initial appointment. If you find any of the questions difficult to answer, please feel free to skip those and we can discuss your concerns in more detail on our initial appointment.
NEW CLIENT INFORMATION
History & Intake Form
For new clients, this form should be filled out and brought with you at the time of your appointment. Please fill out the information to the best of your knowledge and recollection.
At the time of your first appointment, please bring all supplements you are currently taking and a list of any prescribed and/or over the counter medications.