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This questionnaire is a guide in helping to prepare for a homoeopathic examination. It is further an information what questions will be asked during a homoeopathic consultation. For the patients it is very important to observe ones symptoms very carefully. The more careful you can tell and describe your symptoms the more the right remedy can be found. In homoeopathy everything depends on the description of the symptoms. According to them the remedy will be chosen:

What complaints do you have? Describe your complaints in your own words:
What drugs do you take now?
At what time of the day are you the worst? Morning? Evening? Night?
After waking? After sleeping? Etc.
How do you react to the weather? Cold-warm-humid-dry-foggy-windy?
How do you react to draft? Exposure to Sun? Snowing? Change of Weather?
How do you react to warmth? Warm rooms? Sun? Warm bathing? Warmth of bed?
How to you react to cold? Uncovering? Cold Water? Cold food and drinks?
Do you catch a cold easily? Cold feet? Cold parts of the body?
How is your desire for open air?
Do you sweat? In general or on special parts?
Sweat during sleep?
Suppressed foot sweat?
How is your desire for motion? How do you feel during sitting? Standing? Lying (left, right, back, abdomen?)
How do you react to the sea, the mountains?
How can you stand the pressure of clothing, touch?
How is your appetite?
Do you have desire for special food? (Sweet, sour, salty, spicy?) Meat? Fish? Cheese?
Do you have aversion to special food?
Do you have aggravation from special food (Fruits, flatulent, fat food? Milk)?
How is your thirst? Alcohol? Coffee? Cold or warm drinks?
Are you hungry at special times of the day?
How is the bowel motion?

These questions can be related to the general condition but also to every complaint you have.
With every complaint there must be paid attention to following questions:
What circumstance can cause this complaint? (Anger, grief, cold weather, draft, exertion, sweating, etc.)
Where in the body is the exact localisation of your symptoms?
What circumstances can aggravate and ameliorate this symptom? The answers to that question are the most important to find the right remedy.
The exact sensation that is felt in the complaint (burning, drawing, stitching, etc.).
The exact description of the complaint (diarrhoea is watery, bloody, cough is dry, or expectoration is lumpy and yellow).
Are there any concomitant symptoms that accompany a special symptom? (In back pain there is also felt nausea for example)

Do you smoke?
How is the healing if you have a wound?
Do you have prolonged bleeding?
Tendency to have a collapse?
In woman: How is the bleeding during the period? Are there any changes during the time of the period?
Sexual problems?

Very important is the change in the mood during the disease.
Very often the cause of a disease can be found in stress of psychic origin.
What was the most severe grief in your life?
Can you weep?
How do you react to consolation?
What can make you angry?
Are you jealous?
Are there any anxieties in your life?
Have you been anxious as a child? Can you describe your character as a child?
Have you special fears: Heights? Robbers? Death? Dogs or other animals?
How do you react to other people? Do you like company or you prefer to be alone?
If you have grief do you want to speak with someone about or you prefer to solve the problem alone?
How do you react to crowds, to small rooms, elevators?
Can you wait? Are you impatient? Hasty? Always in a hurry?
Did you have grief, anger, disappointment in your life?
Is order in your life important?
How do you react to contradiction?
How do you react if you hear from other people if they are suffering?
How do you react to bad news in TV, to horror movies?
How is your situation at your working place? Your family?
How is your sleeping? Recurring dreams?
Is your sleep disturbed? In what position do you sleep?

It is very important to consider the psychic situation. Homoeopathy is a very holistic system of treating people and it is very successful because the whole person is included in the therapy, not only the physical complaints of the patient.

Did you suffer from other diseases before? Operations?

Accidents? How did you react to vaccinations?

In children: How was the situation of the mother during pregnancy? How was the childbirth? Have there been problems during the first period of life?
How was the development of the child?

Are there diseases in the history of the family, the ancestors: Cancer, tuberculosis, heart problems, allergies, etc.?

Finally you can go through the body from above downwards, to make sure that you haven't forgotten anything important:

Head - Eyes - Ears - Nose - Mouth - Lips - Tongue - Throat - Glands - Chest - Heart - Lungs - Stomach - Liver - Abdomen - Bowel motion - Kidney - Bladder - Genitals - Back - Joints - Skin - Nails.