Questionnaire

Homeopathy Registration Form

Step 1 of 2

  • Enter the name by which you wish to be known.
  • Must be 18+ years.
  • The main medical condition(s) with which you need help.
  • How long have you suffered from the condition? Did anything happen in your life just before it began (such as an operation, an illness, a change in medication, a bereavement)?
  • Describe anything that affects the condition. Examples: worse in the morning, better when heat applied, worse after eating fruit, worse in cold weather.