Case Performa
Homoeopathy is based on individualization so try to give as many details especially, your mental, emotional aspects and your personality as you can. The remedy to be selected will take into consideration all these aspects. Do not hesitate to mention anything however trivial it may sound.
| Name :* |
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| Age :* |
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| Sex :* |
Male
Female |
| Phone:* |
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| E-mail :* |
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| Address : |
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| Occupation : |
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Present Complaints (Its duration, exact place, how it started, factors which increase or decrease the problems and other related symptoms) |
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Past History |
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| Major previous diseases and their treatment |
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Family History |
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| Any history of major diseases in blood related family members |
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Personal History |
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| Appetite |
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Thirst: Thirsty or thirst less
If thirsty, mention quantity and frequency |
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Sensitivity to Hot and Cold weather:
(Write ‘Comfortable’, ‘Uneasy’ etc.) |
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| Cravings or Aversions: Strong desire or aversion to have salty, sweet, spicy or any other specific craving or aversion like chocolates, fruits, juices, non-vegetarian food. |
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| Smoking/Drinking Alcohol/Tobacco or any other stimulant |
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| Sleep and position during sleep |
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| Dreams: Any specific dreams which come frequently |
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Mental and emotional aspect |
| Try to provide information about your basic nature like extrovert or introvert, talkative or quiet, timid or courageous |
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| Also provide prominent positive or negative traits in you like anger, propensity to crying, anxiety, jealousy, secretiveness, suspiciousness, religious, superstitious-ness, sympathy, egoist, sarcasm, obstinacy, timidity |
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| Any prominent fear |
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| Any particular incident which has had an impact on your problem |
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