Satmedica homeopathy

WELCOME TO HOMEOPATHIC ONLINE CONSULTATION DETAILED CASE SHEET
1.	Name:
2.	Address:
3.	Phone number:
4.	E-mail Id:
5.	Age:
6.	Sex:	Male Female
7.	Weight(KGS / LBS) :
8.	Marriage status :	Married Unmarried

9.	STATE CLEARLY YOUR PRESENT ILLNESS AND IT’S STARTING PERIOD.:
10.	State clearly your health and medical history from childhood in chronological order (Including your milestones - sexually trasmitted diseases - recurent infections and fevers - sufferings in weather changes etc).
11.	STATE CLEARLY YOUR FAMILY HEALTH AND MEDICAL HISTORY (ABOUT FATHER – MOTHER – BROTHER – SISTER):
12.	MENTION YOUR VACCINATION PROFILE AND ANY SIDE EFFECTS THEREON.
13.	MENTION ABOUT ANY DRUG REACTIONS / INSECT BITES / DOG BITES / ACCIDENTS / SURGERIES ETC.
14.	SPECIFY YOUR PHYSICAL FRAME (OBESE / LEAN / SLENDER).

15.

MENTION YOUR DESIRES / LIKINGS AND AVERSIONS / DISLIKINGS AND REACTIONS TO THAT IF ANY.

FOOD ITEMS:	DESIRES/ LIKINGS	AVERSION/ DISLIKINGS	REACTIONS IF ANY
SWEETS :
SALT /SALTY :
SOUR / LEMONADES :
MILK / MILK PRODUCTS :
COFFEE / TEA :
SPICY :
POTATOS :
COLD FOODS / DRINKS :
WARM OR HOT FOODS / DRINKS.

16.

MENTION CLEARLY YOUR FEELINGS IN GENERAL AND REACTION OF YOUR SUFFERINGS UNDER THE FOLLOWING CONDITIONS.

(eg. I enjoy and feel happy in cold weather but my cough and cold worsen in cold weather).

CONDITIONS	I ENJOY & FEEL HAPPY	I HATE & FEEL BAD	BETTER MY SUFFERINGS	WORSE MY SUFFERINGS.
WARM/HOT WEATHER
COOL/COLD WEATHER
RAINY SEASON
CLOUDY WEATHER
THUNDER AND STORM
WARM BATHING
COLD BATHING
SUN BATH
SUN EXPOSURE
LYING ON BACK
LYING ON LEFT SIDE
LYING ON RIGHT SIDE
LYING ON ABDOMEN
LYING ON PAINFUL SIDE
LOOKING FROM HIGH PLACES
IN CROWD
IN CLOSED ROOMS / CHURCHES
FULL MOON
NEW MOON
NIGHT
WHEN ALONE
WHEN WITH FRIENDS/ COMPANY
ANY OTHER CONDITIONS.

17.

FEMALE PROBLEMS:

(A)	DETAILS OF MENSTRUATION (Regular / Irregular / Delayed / Profuse / Scanty / On set of Menopause, etc).
(B)	ANY MENTAL OR PHYSICAL SUFFERING BEFORE / DURING / AFTER MENSTRUATION.
(C)	ANY GYNIC PROBLEMS LIKE FIBROIDS / UTERUS OR CERVICAL EROSION / OVARIAN CYSTS OR TUMORS.
(D)	ANY LEUCORRHOEA AND ASSOCIATED PROBLEMS.
(E)	STATE ABOUT YOUR SEXUAL SPHERE.
(F)	USING ANY CONTRACEPTIVES OR HABIT OF TAKING OF THESE ?
(G)	ANY PROBLEMS WITH FEMALE ORGANS?.
(H)	ANY CYSTS / TUMORS / IN BREASTS ?

18.

MALE PROBLEMS :

ANY PROBLEMS WITH MALE GENITALS? STATE ABOUT YOUR SEXUAL SPHERE?. ANY EJACULATION AND ERECTION PROBLEMS?

19.

MENTION CLEARLY ANY RELATED DISEASES OR SUFFERINGS OF THE FOLLOWING ORGANS OR SYSTEMS.

a.	Vertigo or Dizziness.
b.	Head and Scalp: (Headache – Skin problems on scalp – Alopecia etc).
c.	EYES AND VISION: (Recurrent conjunctivitis – Styes – Neurological pains – etc)
d.	EAR AND HEARING: (Ear discharges – pain - Loss of hearing – Sounds in ears etc.)
e.	NOSE : (Colds – Polyps – Snoring – Sinusitis etc).
f.	FACE : (Acne – Discoloration – Eruptions – Neurological pains etc).
g.	MOUTH AND TONGUE : (Ulcers – etc).
h.	TEETH AND GUMS : ( Caries of teeth – Gum boils – Gum bleeding etc).
i.	THROAT AND LARYNIX : ( Tonsils – Ulcers – Voice problems etc).
j.	CHEST / LUNGS / HEART / RIBCAGE :
k.	LIVER / GALLBLADDER / PANCREATIC GLAND :
l.	ABDOMEN AND STOMACh: ( Appetite – Thirst - Gastritis – Ulcers – Colic – Hernia – Vomiting etc).
m.	KIDNEYS:
n.	RECTUM AND ANUS: (Piles – Fissures – Fistula – Constipation etc).
o.	BLADDER AND URINE:
p.	SKIN DISEASES
q.	MUSCLES AND BONE AND JOINTS:

20.

YOUR EMOTIONS AND MIND STUDY:

Homeopathic case study requires your behavior and mind status also for suggesting a successful homeopathic medical advice. As such we need detailed information about you and your mind. The following items are to be carefully described.

Example No 1. : This is illustrated for your guidance. ANGER AND IRRITABILITY : I get anger and irritation when other person does not hear my words and I get very irritation and control myself from not shouting or beating him. During such time I get shivering, trembling of speech, sweating which disturbs my sleep also. Of course in the morning I will become normal.

Example No 2. ANXIOUS AND NERVOUSNESS : When I am expecting guests or before journey I become anxious and my stomach get nauseated and cause one or two stools or frequent urination. After the guests came and become normal and move without any anxiety or nervousness.

You shall inform (1) the state of emotion or mind state (2) the causation of such emotion or mind state (3)
the condition of your physical body or sufferings (4) the abnormality in this state of emotion or mind.

Please describe and narrate in detail in your words with examples or incidents if any.

(A).

ANXIOUS AND NERVOUSNESS:
ANGER AND IRRITABILITY:
RESTLESSNESS AND IMPATIENCE:
HURRY OR HURRIED MIND:
FEARS AND PHOBIAS:
SENSITIVITY:
JEALOUS STATE:
SAD / DEPRESSION / DESPAIR :
SEXUAL AND EROTIC STATE OF MIND:
EMOTIONAL AND IMPULSIVE:
WEEPING AND CRYING MOOD:
FASTIDIOUSNESS OR CLEALINESS:
SUICIDAL TENDENCY OR THOUGHTS:
SYMPATHETIC AND KINDFUL:
ABOUT YOUR MEMORY AND CONCENTRATION
ABOUT YOUR THOUGHTS.
ABOUT ANY ILLUSIONS OR DELUSIONS.

(B).

Are you offend easily?	YES	NO
Are you Egoistic? Proud?	YES	NO
Are you Pessimistic?	YES	NO
Are you Fault finder?	YES	NO
Are you Adamant or Obstinate?	YES	NO
Are you Yield easily to others?	YES	NO
Do you like Company or Friends meeting?	YES	NO
Do you like Loneliness?	YES	NO
Do you hate Consolation / Sympathy?	YES	NO
Do you feel better when others show sympathy on you?	YES	NO
Are you Revengeful?	YES	NO
Are you Bashful?	YES	NO
Are you much Religious?	YES	NO
Can you tolerate injustice caused to others?	YES	NO
Will you fight for others cause and shoulder responsibility?	YES	NO
Are you selfish or self centered?	YES	NO

(C).	PLEASE MENTION ANY SUFFERINGS OR AILMENTS AFTER THE GIVEN INCIDENTS OR SITUATIONS: (SINCE LOSS OF LOVE -SINCE DEATH OF LOVED ONE.-SINCE FAILURES IN LIFE.-SINCE HURT OR INSULTS.-SINCE DIVORCE.-SINCE STOPPING OF HABITS OR ADDICTIONS.).

(D).	WHAT MAKES YOU HAPPY AND JOY?

(E).	PLEASE STATE ANY FURTHER INFORMATION ABOUT YOUR EMOTIONS - UNUSUAL BEHAVIOUR – MENTAL STATE ETC.

21.

ABOUT YOUR PERSPIRATION :
(Profuse – Scanty – Odor – Perspired parts – Sweat Stain etc).

22.

ABOUT YOUR SLEEP:
(Sleeping problems like insomnia etc – Position of sleep in the bed – Snoring in the sleep ).
Do you cover the blanket during sleep, if so, up to neck or cover the total head or what are the covering parts ? Do you keep feet outside the blanket ?

23.

ABOUT YOUR DREAMS : Mentions the dreams you get frequently.