General Direction Before Filling Case Proforma/Form :

It is important that you must read this before filling this form:

As in homeopathic treatment, the remedy selection is based on “totality of symptoms”, so it is very important to ask so many questions to you. Each one of these questions has a definite meaning and significance for us. There is not a single question that is useless. Even something that your may think is not connected with your trouble, may be the most important factor in deciding the correct homoeopathic medicine.

• That is why you must be free and frank and give us the fullest possible information on each point.
• Please read each question carefully, think and if necessary, consult someone close to you and then answer completely. Do not keep anything back.
• We need to know ALL POSSIBLE DETAILS ABOUT YOUR DISEASE which you noticed about yourself.
• Try to avoid medical terminology and narrate your details in your own words as if describing your complaints to a family member or friend.

This Case Proforma/form has 10 parts:

1. Description of your main presenting complaint/complaints.
2. General physical appearance
3. About your past illness. Please take time to answer this part, preferably taking the help of family members.
4. About your family history. Any major illness in your family including grandparents n maternal grandparents, your siblings etc is present, please describe here.
5. Your personal information
6. General signs & symptoms. Another very important part to individualize you like your hunger, thirst, sweating etc.
7. Systematic symptoms. Here you have to explain body system wise symptoms like your digestive system, respiratory etc.
8. Please attach your all reports and prevous prescription which you had taken earlier.
9. Mental and emotional symptoms. Please write in this part about your situation in life and about all the things that are bothering you. Be totally frank and open.
10. Some other information. In this section you can write any information about yourself which you have not mentioned yet.

Note : Whatever you tell us will remain absolutely CONFIDENTIAL.