Homeopathy Papers

Tidbits 73: The Questionnaires

Tidbits 73: The Questionnaires 1

I’m letting you have my homeopathy questionnaires (acute & chronic), for: adults, children, teens & pets

It’s pretty easy to google and find many renditions of the constitutional questionnaire in homeopathy; but not so easy to find a questionnaire for acutes, kids, pets and teens.  They say a case well-taken is half-solved; so, knowing what to ask is essential.

So often, homeopaths can be blind-sided by a patient’s complaints; like a deer in the headlights, bombarded by so much dire information at once, where does one begin?  I can remember times where all I could think to say was, “Have you thought about seeing a doctor?”

And then I remember what I’m supposed to ask!  Originally, I kept a copy of the Acute Case Questionnaire in my wallet so I’d never be caught flat-footed again!  You know, if your patients have filled out a questionnaire, you can always refer back to it, use it to inform your follow-up questions, and you never have to worry that you’ll forget their details — their food desires and aversions, what makes them better or worse, what types of pains they had or their aggravation time, etc.

When you’re working with a questionnaire, you can sit quietly with it for as long as needed, uninterrupted, with your Repertory and Materia Medica open, cross-checking remedies and symptoms, conferring with other homeopaths if need be; and when you’re fully prepared, you can fire off your follow-up questions. 

Patients say to me, “I can take the day off and come to see you in person,” and I tell them, “But by the time I’ve read your questionnaire and asked a few follow-up questions, I’ll already know your remedy!”  And in this era of COVID 19 and “stay-at-home” orders, the questionnaire is more important than ever!  To that end, scroll down, find the questionnaire that suits your needs, copy and paste it to a document or your email window, and send it off!

First, a bonus for you:  Your patient unfamiliar with homeopathy is going to recoil at the sheer number of questions — a lot of them seeming irrelevant!  Here’s an article that will help them understand what we’re looking for and why:

The Homeopathic Interview: Why We Ask What We Ask

__________________________

Homeopathic Questionnaire for Adults

(Constitutional and Chronic Cases)

(Hint:  The more information you give, the easier it will be to solve your case and the fewer follow-up questions I’ll need  to ask.)

Name:

Address:

Phone number:

Email Address:

Age:

Weight:

Height:

Gender (male or female):

Occupation:

Date:

CHIEF COMPLAINT

  1. Chief complaint–Tell as much as you can including how long it’s been going on and whether it came on suddenly or gradually. If there’s more than one chief complaint, start with the most recent thing and then move on to the next.
  1. Do you know what caused your complaint (s)? If not, talk about what was going on in your life at or around the time that the complaint(s) started.  Typical causes include lingering effects of a virus, injury or insect or animal bite; emotional upsets, prescription or recreational drugs, alcohol, vaccinations, electro-magnetic fields (too much time on the cell phone, computer, etc.), electric blankets, water beds, lack of rest/sleep, eating unhealthfully, the weather, toxins in the environment, etc.
  1. What aggravates your complaint(s)? Another way of asking this is to say, What brings the complaint on/sets it off, or what do you avoid because of it?  When you think about aggravating factors, consider, but don’t limit yourself to: the weather, air conditioning, heated rooms, fresh air, sympathy/consolation, company, being alone, certain foods and drinks, sleep, certain positions like standing or bending over, music, rest, storms, movement/motion, touch, pressure, massage, sunlight, waiting in line, and so on.
  1. What makes the complaint better, even if just a little better or for just a short period of time? Another way of thinking of this question is to ask, What does the complaint force you to do?  For example, if your headache is making you press against your forehead, then you’re better for pressure.  See examples in #3.
  1. At what time of the day or night are you at your worst? Conversely, when are you at your best?
  1. What symptom or symptoms come with the complaint, if any? For example, you can have a headache with nausea or you can have a headache with double vision, or a headache with irritability or sadness and crying, etc.  These additional symptoms are called “concomitants”, meaning, “along with”.
  1. Do you have an issue around weather or environment? For example, some people have an aggravation of their complaints in dry weather, or every spring, etc.; others get worse in windy weather while others are worse before a storm, still others can’t tolerate the heat or the cold but are better in mountain air, or ocean air, etc.
  1. Is there a position that’s aggravating? For example, stooping, lying flat, lying on the stomach or left side, walking, sitting, etc.
  1. Do you tend to be chilly or warm?
  1. Are there parts of you that are colder or warmer; such as, cold feet, cold hands, cold nose, etc.?
  1. Tell me about perspiration if you consider it a problem: Where on your body do you perspire; for instance, the back of your head, the top of your head, during sleep, etc.?  Does the perspiration have an identifiable odor?  A color?
  1. Have a look at your tongue and tell me what it looks like–for instance, coated, coloring, cracked, mapped, scalloped edges, etc..

MENTAL/EMOTIONAL

  1. Describe your nature.
  1. When you’re not occupied, what thoughts come to mind?
  1. What makes you very happy?
  1. What part or parts of your life should never have happened?
  1. What in your life makes you the most sad?
  1. Tell me about the kind of entertainment you’re drawn to.
  1. Tell me what’s peculiar about you. I know this is an unusual question and most people say, “Nothing, I’m not peculiar at all.”  A few hints might be: Are there things your well-meaning friends and family try to change about you or help you with or nag you about?  What we’re trying to do here is find out how you’re different, even special, in relation to the average person.
  1. What would you like to change about yourself?
  1. What stops you from moving forward to where you want or need to be?
  1. What are you most proud of?
  1. What role do you play in relationships? For example, some people take the role of “leader” or “boss”, while others are followers, or helpers, peace-makers, rescuers, care-givers, trouble-makers, etc.  Try and give examples, don’t just say, “I’m a trouble-maker” and leave it at that, tell me what you mean.
  1. What happens to you over and over again? (“The story of my life!” as they say.)
  1. How neat are you? Think about your home, office, room, desk, closet, kitchen, etc.?
  1. What makes you cry?
  1. What’s taking your energy away, draining you of energy?
  1. What makes you angry? What do you do when you get angry?
  1. Do you have an emotion that predominates?
  1. What fears do you have? For example, dogs, insects, bridges, snakes, authority figures, airplanes, ghosts, disease, germs, leaving the house, being alone, the dark, night, noises, death, dying, accidents, public-speaking, social gatherings, etc.
  1. What was your childhood like?
  1. What bothers you most in other people?
  1. What causes the most problems in your relationships–past or present? (That could be a relationship with someone of the opposite sex or just the friends in your social circle or family members.)
  1. What would you need to feel happy?
  1. What do you do at your job–or did you do, if you’re no longer working? How do you feel about your job?  (If you’re a student, that’s your job.)
  1. If you were made president for a day, what would you change? (People sometimes answer this by saying, “One day isn’t time enough to change anything!”  Precisely because it’s not very much time, you would have to pick the one thing you were REALLY concerned about!  For example, if I had to answer, I might say, “Give those kids at the Mexican Border back to their parents!” which would say what about me?  That I’m empathetic, feel others’ pain, can’t tolerate cruelty, etc., which would tend to rule out certain remedies known for being unsympathetic and selfish.)
  1. When people have criticized you, what was the criticism about? Similarly, when people have praised you, what did you receive praise for?

FOOD

  1. Give an idea of what a typical day of eating looks like for you–that would include the menu and the time that it’s eaten. In fact, for the next couple of days, you could simply make a note of everything you eat and what time you eat or drink it.
  1. What would you most like to eat if you could eat anything? What did you used to eat when you were “healthy”, before starting your “diet”, or “turning your life around”, etc.
  1. Is there a food you simply MUST have or you’d feel deprived?
  1. Is your preference for creamy, tart, salty, spicy or sweet or any combination thereof?
  1. Is there something you like to eat that most people would consider odd, like vinegar or lemons or chalk, etc.?
  1. Are there foods that you love but they don’t agree with you?
  1. What foods do you have an aversion to?
  1. Describe your thirst and drinking habits. For instance, how thirsty are you?  Do your drinks have to be cold?  Do you take ice with your drinks?  Do you just take a sip and you’re done or do you take several swallows at a time?  Some people are forcing themselves to drink because they’ve heard it’s good for you.  This doesn’t really count as “thirst” or “thirsty”; so, if you’re drinking a lot of something, be sure to say why.

SLEEP

  1. Any issues about sleeping?
  1. What do you do during sleep–throw off the covers? Stick your feet out?  Snore?  Toss and turn?  Talk?  Scream?  Walk?  Grind your teeth?  Drool?  Does the light have to be on?  Does the window have to be open?  etc.?
  1. What position do you sleep in?

WOMEN

  1. Trouble with your cycle, periods or menopause? Trouble with reproductive organs?
  1. Trouble with pregnancy, childbirth or recovering afterwards?

HEALTH HISTORY

  1. What medications are you on now or recently got off of?
  1. What homeopathic remedies have you had? Please include the potency and dosing schedule.  Did any of them help you?
  1. Are any of your problems caused by a vaccination, antibiotic or other drug?
  1. Any surgery? What and when?  What’s your assessment of it, did you get good or bad results?
  1. Any head injuries? When?  Any lingering effects?
  1. Talk about your skin: any moles, warts, cysts, tumors, rashes, eczema, etc.?  How were they treated?
  1. Any discharges? If so, I need to know the color, odor, sensation and consistency.  For example:  “Nasal discharge, like a faucet, watery, burns my upper lip; no odor.  Watery discharge from my eyes, makes my eyes itch.”
  1. What diseases run in your family?
  1. Time-line. I need the “significant events” of your life and your age when they happened. Reason for this question: we’re always looking for causes, things that might explain your current situation.  We’re looking for “layers”.  We like to be able to say, “He looks like a constitutional Phosphorus, then became Nat-mur after his parents divorced and went into Nat-sulph after the head injury in the car accident.”  This way, we know to give Nat-sulph. first, followed by Nat-mur, and Phosphorus last.  So, for example, your answer  might look something like this:age 2 — hernia operation
    age 8 — tonsils out
    age 13–parents divorced, we had to move out of our house, changed schools, lost my friends, felt like an outcast.
    age 16–lost first boyfriend, never the same after that, lost all joy in life, went into a shell, never bounced back. I still keep to myself even now.…and so on

SENSITIVITY

  1. What are you sensitive to?  Consider allergens, fumes, sad stories, music, noise, criticism, clutter, injustice, etc.

MISCELLANEOUS

  1. When you have to wait in line, how do you feel?
  1. How do you respond when a family member is sick?
  1. Any issues with sex?
  1. How do you react to consolation and sympathy?
  1. What sorts of things do you consider to be ordeals?
  1. What are your hobbies?
  1. Where would you go if you could go anywhere?
  1. Anything note-worthy about your face? Freckles?  Haggard expression?  Frown?  Acne, etc.?
  1. Anything note-worthy about your voice; such as, stuttering, slow speech, hasty speech, whining, etc.?
  1. Who in your life is a very difficult person and why?
  1. If you won the lottery, what would you do with the money?
  1. Describe your energy.
  1. Is there anything that really gets on your nerves?
  1. Are there any topics you seem obsessed with?
  1. What was your ambition in childhood?  What’s your ambition now?

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Adolescent Questionnaire

(In reading this questionnaire over, I’ve noticed that it possibly lends itself toward giving one or two-word, superficial answers.  I can assure you that that will not help me find a remedy!  Remember, my goal here is to get to know you as a person and especially how you differ from everybody else in your age group.)

Adolescent’s name:

Parent’s name:

Address:

Telephone number:

Parent’s email address:

Date:

Gender (male or female):

Weight:

Height:

Date of Birth:

Body type (tall/thin, short/fat, tall/fat, short/thin, short/stocky, average, etc.):

Nationality/race:

(Reason for this last question–some things are normal for certain cultures and, therefore, homeopaths don’t give them much attention; for example, people from India desire spicy food; that’s normal.  Americans desiring spicy food, on the other hand, is something to make note of.  Americans are more likely to desire sweets.)

 

  1. What is the chief complaint?  If there is more than one complaint, start with the most recent one and then move on to the next.  Tell as much about it/them as you can.
  1. When did the problem/s start if not already mentioned?  What was going on in your life around that time?  Was there an event after which it all seemed to start?  Do you have a theory about what caused your problem/s?
  1. What aggravates your complaint/s?  What makes it (or you) worse?  Think about any and all possibilities, such as certain foods or drinks, the sun, the temperature, noise, bathing, sympathy, missing meals, a certain time of day, music, touch, pressure, being alone, being outside, being in company, having to answer questions, being interrupted, the behavior of other people, etc.
  1. And now the opposite of #3: what makes the complaint, or you, better?  Consider, but don’t limit yourself to, the same examples given above.
  1. What is the worst time of day for you?  For example, the morning on waking?  From 4-8 P.M.?  2 A.M.?  Midnight? etc. and why is it the worst time?  What happens at that time?
  1. What symptoms accompany the chief complaint (and your other complaints) if you haven’t already said? For example, a headache can be accompanied by hot feet, runny eyes, thirst for ice cold drinks, nausea, visual complaints, etc.  These additional symptoms are called “concomitants”.  Concomitant means “along with” or “accompanied by”.
  1. (This question is for Mom and Dad, and all questions up to and including # 11, though Mom and Dad, other family members and your best friends, etc. are certainly welcome to add their “2 cents” to any of the other questions too with your permission.) What was the pregnancy and birth like?  Anything remarkable to report?  Any traumas?  Complications?  Any drugs used like anesthesia, etc.?  Anything to report about the mother’s health and disposition during pregnancy?  Did she take any drugs or alcohol or cigarettes or marijuana, etc.?
  1. Father’s health at time of conception: What was the father’s state of health and temperament?  Was the father on any strong or addicting substances at the time of conception (see above examples)?
  1. The child’s milestones: was he late or early in learning to–crawl, walk, talk, wean, teethe, toilet-train, etc.?
  1. Was the child vaccinated? Which ones did he have?  Did he have a reaction to any of them?
  1. How did the child react to the birth of a younger sibling? How would you describe his or her childhood from your standpoint?
  1. How do you react to school, what issues/problems do you have with it?
  1. How do you feel about spending the night away from home?
  1. How do you feel about traveling?
  1. Give an idea of how much prescription drug treatment you’ve had over the years, and for what? Have these drugs caused you any problems?
  1. Any skin conditions treated with cortisone-type cream?
  1. Did you have an especially severe childhood illness? Explain.
  1. When you’re ill or upset, to what extent do you want sympathy, consolation and support; or would you prefer to be alone?
  1. What are your well-meaning friends and relatives always trying to change about you or help you with?
  1. What feed-back do you get from teachers, school counselors, camp counselors, coaches, etc.?
  1. How do you feel about and treat animals? Are there any animals you have a strong attraction to or aversion to?
  1. What foods and drinks do you love?
  1. What foods and drinks do you have an aversion to?
  1. Do you desire ice or ice-cold drinks?
  1. Describe the kind of eater you are.
  1. What fears do you have? (Think! think! think!  We’re all afraid of something!  For example: heights, dogs, elevators, authority figures, insects, swimming in the ocean, germs, getting sick, abandonment, and so on.)
  1. Do you tend to be chilly or hot?
  1. When are you most likely to perspire and where on your body?
  1. How affectionate are you?
  1. How sympathetic are you? (Affected by the suffering of others)
  1. How affected are you by music?
  1. What emotion tends to predominate in you?
  1. How neat or messy are you? Think about your room, your desk, your locker, etc.
  1. How sensitive are you to criticism or reprimand?
  1. Do you have any digestive complaints?
  1. Any complaints with sleep?
  1. Any skin issues–warts, moles, rashes, acne, etc.? If we’re talking about a rash or acne, I’ll need you to describe it, tell me where it is, what sensation it causes (itching, pain, etc.) and what makes it better or worse–for example: hot applications, cold applications, touch, clothing, rainy weather, a certain time of day or night or season, etc.
  1. What is most striking, defining or characteristic about you?
  1. How cooperative are you?
  1. What’s standing in your way of moving ahead, making progress, reaching your goals?
  1. How often do you get sick? Do you tend toward certain ailments?
  1. Ask your mom what illnesses run in the family.
  1. What do you really love to do?
  1. Time-line (you may need your parent’s help): Make a list of traumatic events, from birth onward, whether physical or emotional, in order of occurrence, including such things as injuries, surgeries, drug therapies, emotional upsets, losses, disappointments, etc., that occurred in your life that had a profound effect on you and changed you in some way.  Include your age at the time, and how you coped/responded.
  1. Are you on any drugs or supplements at the moment, if not already stated?
  1. Do you throw the covers off at night or stick your feet out of the covers?
  1. Please give me an idea of what you eat/drink in a day. You can start by telling me what you ate yesterday, if that was an average-type day of eating in your household.  Give me the approximate time of eating as well.  It’s just as important to know how your meals are spaced out, as what you’re eating.
  1. Who’s a difficult person or persons in your life and why?
  1. Describe your nature.
  1. What do you want to change about yourself?
  1. What happens to you over and over again (the “story of my life”, as they say)?
  1. What are you most proud of?
  1. What makes you cry?
  1. What makes you angry? What do you do when you get angry?
  1. What bothers you most in other people, how do you respond to it?
  1. Describe your thirst/drinking habits.
  1. Sleeping: Any issues here, anything you’d like changed?  What position do you sleep in?
  1. What are you sensitive to? Think about noise, clutter, criticism, sad stories, sad movies, insects, injustice, music, the sun, the cold, pollen, fumes, etc.
  1. Anything note-worthy about your appearance or your voice? For example, freckles, red hair, frowning, stuttering, whining, soft voice, loud voice, fast-talking, interrupting, etc.
  1. What really gets on your nerves?
  1. What’s your ambition?
  1. Describe your energy (for example, are you slow, sluggish, hyper-active, peppy, enthusiastic, nervous, jittery, etc.?)

______________________________________

Children’s Questionnaire

(The more information you give, the easier it will be for me to find the remedy.)

Name of child:

Client’s name:

Address:

Telephone number:

Email address:

Date:

Gender (male or female):

Weight:

Height:

Date of Birth:

Body type (tall/thin, short/fat, tall/fat, short/thin, short/stocky, average, etc.):

Nationality/race (we ask this question because certain traits are normal for some groups but unusual for others):

 

  1. What is the chief complaint? Tell as much about it as you can.
  1. When did the problem start if not already mentioned? What was going on in the child’s life around that time that could explain the complaint?  Was there an event or series of events after which he or she was not the same?  Do you have a theory about what caused it?
  1. What aggravates the complaint? What makes it worse?  Think about any and all possibilities, such as certain foods or drinks, the sun, the temperature, noise, bathing, sympathy, missing meals, a certain time of day, music, touch, pressure, being alone, being outside, having to answer questions, being interrupted, bending forward, bending back, rubbing, etc.
  1. And now the opposite of #3: what makes the complaint better? Consider, but don’t limit yourself to, the same examples given above.
  1. What is the worst time of day for your child. For example, the morning on waking, from 4-8 P.M., 2 A.M., etc. and why is it the worst time?  What happens at that time?
  1. What symptoms accompany the chief complaint if you haven’t already said? For example, a headache can be accompanied by hot feet, runny eyes, thirst for ice cold drinks, nausea, crying, etc.  These additional symptoms are called “concomitants”.  Concomitant means “associated with”.
  1. What was the mother’s pregnancy and birth like? Any traumas?  Complications?  Any drugs used?  Anything to report about the mother’s health and disposition during pregnancy?  Did she take any drugs or alcohol or cigarettes or marijuana, etc.?
  1. Father’s health at time of conception: What was the father’s state of health and temperament?  Was the father on any strong or addicting substances at the time of conception including Rx drugs, alcohol, etc.?
  1. The child’s milestones: was he late or early in learning to–crawl, walk, talk, wean, teethe, toilet-train, etc.?
  1. Was the child vaccinated? Which ones did he have?  Did he have a reaction to any of them?
  1. How did the child react to the birth of a younger sibling?
  1. How does the child react to school?
  1. How does the child react to spending the night away from home?
  1. How does the child react to travelling?
  1. How many rounds of antibiotics or other drugs has the child had and for what?
  1. Any skin conditions treated with cortisone-type cream?
  1. Did the child have an especially severe childhood illness?
  1. When your child is ill or upset, does he want to cling or be left alone?
  1. How would you describe your child’s behavior when interacting with his or her peers?
  1. What feed-back do you get from the child’s teachers, baby sitters, school counselors, camp counselors, etc.?
  1. How does your child feel about and treat animals?
  1. What foods and drinks does your child love?
  1. What foods and drinks does your child hate?
  1. Does your child want ice or ice-cold drinks? How thirsty is he or she?
  1. Describe the kind of eater he or she is–fussy, picky, etc.
  1. What fears does your child have?
  1. Does your child tend to be chilly or hot?
  1. When is your child most likely to perspire and on what parts of the body?
  1. How affectionate is your child?
  1. How sympathetic is the child? (Affected by the suffering of others)
  1. How is the child affected by music?
  1. What emotion tends to predominate in the child?
  1. How neat or messy is the child?
  1. How sensitive is the child to criticism and reprimand?
  1. Are there any digestive complaints?
  1. Any complaints with the child’s sleep?
  1. Any skin issues–warts, moles, eczema, etc.?
  1. What is most striking, defining or characteristic about your child?
  1. How cooperative is your child?
  1. What’s standing in his or her way of getting ahead?
  1. How often does the child get sick? Does he tend toward certain ailments?
  1. What illnesses run in the family?
  1. What does the child really love to do?
  1. Does your child have any peculiar “sensations” or “traits” that may or may not have anything to do with the chief complaint? For instance, the child’s face may flush easily, or he may have freckles, or he may be very talkative–rapidly switching from one topic to another or he may have a subject he talks about over and over again; he may have a tightness sensation in the throat, a feeling of bladder fullness; or he may look away when others try to talk to him, or he may turn to the side when you try to hug him; or anything else that might be considered characteristic or peculiar just to him.  Give it some thought.
  1. Time-line: Make a list of traumatic events, whether physical or emotional, including such things as injuries, illnesses, surgeries, disappointments, losses, etc. that occurred in your child’s life and his age when they occurred.  Include information on how he got over the event or recovered, if he did recover.  What I’m trying to do here is piece together the story that led up to what brings you here today, I need to make sense of what happened to your child.
  1. Is your child on any drugs or supplements at the moment, if not already stated?
  1. Does your child throw the covers off at night or stick his or her feet out of the covers?
  1. For the next two days, every time your child eats or drinks something, write it down, along with the time, and report back here. Make sure you don’t change what he’s eating just for my benefit.

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 Questionnaire For Acutes and Pathology

Name:

Age:

Male or Female:

Weight:

Height:

Date:

Email Address:

  1. Describe the complaint in your own words in as much detail as you can. Please include the onset, when did it start, how long ago?  How old were you?  Did it come on suddenly or gradually?

2. Etiology–this means the CAUSE, if you know it. What caused the complaint?  Think about what was going on at, or around, the time of occurrence?  The answer may be obvious if you were stung by a bee, ate a big fatty meal, or fell from a height; but, less obvious etiologies would include things like the weather (“Every time it rains, this happens…”), suppression (“I was very angry but said nothing.”, “I had a rash and suppressed it with some sort of cream, then I got asthma.”), over-studying, receiving good news or bad news, having to put up with rudeness, loss of vital fluids – from diarrhea, nursing a baby, bleeding, etc.; loss of a loved one, loss of property, jealousy, fright, use of drugs – prescription or otherwise – never recovering completely from an infection like the flu or other illness/disease, loss of sleep, surgery, too much alcohol, too much junk food, getting the feet wet, drinking cold water on a hot day, embarrassment, breathing in dust, over-exertion, exposure to toxins, vaccinations, etc.  As you can see, you really have to think about this.

3. Sensation–describe the pain or other feeling or sensation you’re experiencing. Does it extend anywhere, does it shoot anywhere?  For instance, “It feels like there’s a crumb in my throat, I’m constantly trying to swallow.  The pain shoots to my left ear.”

4. Appearance– anything remarkable?  Red skin, droopy eyes, besotted look, bloated, edematous, cracks on the corners of the mouth, etc.?

5. Location–where on the body is your complaint located?

6. Modalities–A fancy word which only means:  What makes your complaint better or worse?  Please don’t say “Nothing!”–an answer I frequently get.  THINK!!!!!  This question is very important to us.  Consider the following possibilities: worse or better from hot or cold temperatures, hot or cold bathing/showering, hot or cold applications, hot or cold drinks, warm rooms, fresh air, drafts, motion/movement, sleep, a certain time of day, massage, assuming a certain position; stimuli (conversation, noise, light, touch, pressure, rubbing, music, company, consolation, sympathy, attention, etc.), eating, drinking, ice, hot tea, milk, sweets, chocolate, the weather, etc.  Remember, these are only examples.  Think about your case: what makes you feel better, even if just somewhat better?  What makes you feel worse?  You can also think about: what are you avoiding (worse), what are you doing (better).

7. Concomitants (symptoms that come with the complaint, “along for the ride”, as they say).  Another way of asking this is, “What ELSE is present?” It could be anything: burping, salivating, dizziness, sneezing, anxiety…it could be serious or not serious.  For example: Headache with irritability, headache with runny eyes, menstrual cramps with burping, diarrhea with chills, etc.

8. Discharges–color, odor, consistency and sensation. (A discharge is anything liquid that’s coming out of anywhere.  So, for instance, runny nose, diarrhea, runny eyes, discharge from a rash and so on.)  So, for example, “I have a runny nose that’s clear, watery, oderless, and burns my upper lip.”

8. Generals–these are all the symptoms that begin with the word “I”: I’m hot, I’m cold, I’m hot one minute and cold the next, I’m thirsty, I’m tired, I’m sad, I’m irritable, I’m hungry, I want to be left alone, I want pickles, etc.

9. The mentals: Is the complaint changing you mentally and emotionally?  Think about irritability, panic, anxiety, weepiness, self-pity, confusion, sobbing, dullness, apathy/indifference, overly cheerful, optimistic, pessimistic, whining, complaining, and so on.  In general, how would you describe your nature at this point compared to when you were well?

10. What have you been saying?  For instance: “I’m fine, leave me alone.” “Don’t leave!” “I wanna go home!” “I want ice”, “I want quiet!”, ”Turn that music off!”, “I need help!”  “I don’t need any help, OK?”

11. What are you doing?  For example, tossing and turning, pacing, fidgeting, moaning and groaning, calling people on the phone for support, just lying down and not asking for anything, keeping busy, putting off what has to be done, etc.

12. Describe your thirst and appetite–are you thirsty, not thirsty, what temperature do you want your drinks, what kind of drinks do you want, just sips, or gulps, frequently or infrequently?  Are you craving certain foods or avoiding certain foods?   S. Some people are drinking only because their doctor or someone else told them to.  This doesn’t really count as “thirst”, you have to be able to distinguish genuine thirst from drinking for health reasons.  Similarly, some people are drinking room temperature water only because they heard that ice water is bad for them.  Let me know if you’re eating or drinking something only because of what you heard and not because you really like it.

13. Fever?  Describe.

14. Sweating?    When does the sweating occur?  Where on the body?  Does it leave a stain of a particular color?

15. Odors?  Are odors an issue, such as bad breath, foul or unusual odors of any sort?  Any identifiable odors–like sulphur, onions, rotten eggs, cheese, fish, etc.?

16. What is most striking, peculiar or identifying about your condition?

17. Is there a diagnosis?  For instance, the flu, teething, colitis, asthma, diabetes, etc.

18. Describe your energy–are you nervous, quiet, restless, agitated, sleepy, dull, apathetic, prostrated, collapsed, stuporous, anguished, desperate, active, cheerful, energetic, bubbly, worried, tentative, etc.

19. This question only applies to complaints of a more chronic nature: I need to know what you eat, drink and “take”.  I need to know how long you wait between meals; so, a typical way to answer this question might be:

“For breakfast, I generally have a Danish and a cup of coffee and I take my arthritis pain medicine.  Sometimes I might have orange juice (Tropicana) and sometimes I’ll go to McDonald’s and have an Egg McMuffin.  I usually eat lunch around noon and I’ll have maybe a ham and cheese sandwich with mustard on rye and a Pepsi and I take my arthritis pain medicine again.  At 3:00 I usually have a candy bar or a bag of potato chips and a soda.  After work I have one or two drinks at my local bar before I go home.  I might have a pizza for dinner or order out, maybe Chinese food and I take my multi vitamin tablet then.  I might have chocolate ice cream before bed or maybe a slice of apple pie and I take my arthritis pain medicine again.”

You might even say what you had to eat today, or yesterday or both.

Don’t try to make it look like you eat healthfully if you don’t!  That’s not going to help me.  I would rather hear the absolute awful truth because it is easier for me to solve a case if there is something in it that’s striking, like missing meals or eating mainly sweets or salty things or never eating vegetables or fruit, etc.  Also, if you crave something but are deliberately not eating it for health reasons, that information will help me too.

20. If you have a cough, please tell what it sounds like; for example, “It’s a dry cough that sounds like a saw sawing through wood!” or, “It sounds like a seal barking!” or, “It’s loose and rattling and yet, raising phlegm is very difficult.” or, “It’s dry, it’s a very sharp sound, and it’s very painful, it makes my head hurt, I have to grab my head when I cough.”

21. If you haven’t already said if you’re hot or cold, hotter or colder than usual, or if there’s an issue with your body temperature, like hot feet or cold feet, cold hands, shivering, or hot and cold by turns, etc., say it now.

___________________________________

 Questionnaire For Pets

Your name:

Pet’s name and kind of animal:

Pet’s gender:

Pet’s age:

Your email address:

Date:

Can you send a picture of your pet?

 

  1. What is your pet’s complaint/s?
  1. When did this (these) problems start if not already mentioned?
  1. What was going on the pet’s life around the time this complaint started that might explain it, if not already mentioned.
  1. Describe your pet’s thirst.
  1. Is your pet on medications or supplements?
  1. Describe your pet’s diet.
  1. Are drugs he’s taking causing this problem?
  1. What aggravates your pet’s complaint or what aggravates your pet in general? Think about food, weather, exercise/movement, rest, sleep, eating, noise, heat or cold, company, sympathy, touching, pressure, presence of strangers, being approached, or anything else you can think of.
  1. What ameliorates (soothes) your pet’s complaints? What makes him feel better?  Consider the examples above.
  1. What is the worst part of your pet’s day/night? What happens at that time?
  1. Give a time-line of medical and important events in your pet’s life that may have left a mark on him or her, mentioning his or her age at the time and how he/she coped with them.
  1. Any digestive complaints?
  1. Any skin problems in the past or present?
  1. What’s his or her home-life like?
  1. What’s his or her reaction to the following:
    1. Consolation
    2. Scolding
    3. Noise
    4. Surrounding Activity
    5. Other Dogs/Cats
  1. Does he or she like to be around people or happier alone?
  1. What fears does he/she have?
  1. Describe his or her nature? Is he/she dominant, submissive, aggressive, shy, noisy, quiet, excitable, docile, impulsive, steady, careful, clumsy, gentle, rough, obedient, disobedient, etc.?
  1. How does your pet react to a new person entering the home?
  1. How does he/she react to you or other family members entering the home?
  1. How does he/she react to new situations with new people or new situations with new animals?
  1. Does he/she show anger or hurt if you’ve been away for a long time? How?
  1. Any recent personality changes?
  1. Does your pet prefer to lie in the sun or the shade?
  1. Where does your pet like to sleep?
  1. In what position does he or she sleep?
  1. Is there anything peculiar or striking about your animal’s behavior or symptoms?

_________________________

That’s all folks!  See you again next time!

_________________________

Elaine Lewis, DHom, CHom

Elaine takes online cases. Write to her at [email protected]

Visit her website: https://ElaineLewis.hpathy.com

About the author

Elaine Lewis

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at [email protected]
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at:
https://elainelewis.hpathy.com/ and TheSilhouettes.org

9 Comments

    • Hello, Dr. Gupta; did you scroll down and see the questionnaire for pathologies and acutes? It’s much shorter, and you only have to memorize a few basic questions:

      1. diagnosis (What’s wrong with you? Why are you here?)
      2. etiology (What caused this condition to happen?)
      3. The BIG FOUR: Sensation, Location, Modalities, Concomitants!
      4. The mental/emotionals (how are you changed mentally/emotionally since this condition came on? How are you different?)
      5. Has your thirst changed from normal? Are you craving anything–food or drink? Do you have an aversion to anything you usually like?
      6. What is most striking, unusual about your case, your complaint? What stands out?
      7. Body temperature, is it different than normal: Are you hot or cold? Hot and cold by turns? Fever? Chills? Shivering? Sweating? Are certain parts hotter or colder than other parts? Cold hands and feet? Hot head? etc.?

      Can you remember that much? You would at least have to know that much to find the remedy someone needs in a short amount of time. Like I said, I used to carry the acute case questionnaire in my wallet; you could print out just this much and always have it with you so you’d know what to ask when you have 100 patients to see in a day.

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