Hahnemann Homoeo Dispensary

1) Present Complaints:

Please give accurate description regarding the nature of complaint/ duration/sensation/ area/location, factors increasing or reliving the complaints / associated complaints. For e.g. Pain Abdomen, since 6 months Burning pain, Upper Abdomen, Increased after taking food, relived by hot fomentation, associated with Nausea etc)

2) Personal History

a) Date of birth. Complications during birth... Mile stones of Growth

b) Habits- Smoking, Snuff, Alcohol, Drugs, Tobacco, Chewing, Tea/Coffee, Sleeping/ Any other with duration

c) Past ailment History – With a short description and Treatment adopted

D) Occupational History: - Condition and surroundings of the place of Work, Nature of work, Atmosphere at work, Relationship with subordinates and Superiors
3) Family Ailment history-Give a brief Description about the duration and history of ailments of father, Mother, Brothers Sisters Grand father, Grand Mother Aunts and Uncles from both Maternal & paternal side
For E.g. Asthma, Bleeding Tendency, Cancer, Epilepsy/fits, Diabetes. Hepatitis, Paralysis, Heart problems, Kidney Problems, Hypertension, Hypotension, Mental ailments, Liver Diseases, Arthritis, Tumors, Skin Diseases, Neurological conditions etc.
4) Appetite& Thirst – Good, Excessive, Wanting etc
5) Likes and dislikes regarding Food, taste and drinks Sweet, Bitter, Spicy,warm, cold Vegetarian (items) Non Vegetarian (items), Please state if any food or drink disagrees or increases complaints
6) Perspiration: Profuse/ Scanty, Smell, Generalized / of parts only
7) Urine: Profuse/ altered, Quantity/ pain/ Smell and color/ sediments
8) Stool/ Motion: No of times/ Constipated/ loose. Colour, smell
9) General:- Weather/Climate you are better or worse – Increase or decrease of your complaints, Likes covering while sleeping or Not, Bathing in Hot or Cold water, Warmth or Cold felt on body
10) For Men Sexual Habits, Masturbation tendencies, Erection Problems, Ejaculation problems/ Sexual desire, any other problem
11) For Women First Periods (Age), any complaints associated with Menses, How long it last, how is the flow, duration. Menopause and if any menopausal symptoms are there, any problems faced during child birth or pregnancy, Leucorrhea (Nature and associated complaints) Sexual habits, Sexual desire
12) Sleep and dreams- Duration and nature, refreshing/ unrefreshing, position for sleep, type of dreams, dreams
13) Mind A few sample Questions for your kind consideration, please go through the questions and kindly make us know to us freely Your General Reaction towards Society family friends etc.

1. Do you get anxious? If so sate when/for what/ without any cause
2. Have got any fears? Animals, Lightning Thunder, Unreasonable, being alone, People, opposite sex, darkness, etc.
3. How do hurts affect you? Cannot Forgive people hurt you, revengeful etc?
4. Do you get offended easily?
5. Are you a perfectionist?
6. Have you ever felt jealous? If so when-Describe your feelings
7. Have you ever thought of suicide? If so when and do suicidal thoughts trouble you?
8. How is Your Memory? About names, Places, events in life, etc.
9. Do you like company? If so Why/ If not Why?
10. Do you feel depressed/ If so when?
11. Do you weep easily? If so what makes you weep?
12. What is the effect of consolation or sympathy on you?
13. State the greatest joy and sadness you have experienced in life?
14. What makes you different from other people? What are personality traits in you?
15. Waht is the opinion of others regarding Your Behavioral nature?
16. What is your opinion about yourself?
17. Please give an idea about your ambitions, aims Self-esteem,
18. Effect of sympathy or consolation on you
19. Your attitude towards tidiness and cleanliness