The Homeopathic Questionnaire

When you book in for your initial consultation for homeopathy with Clare, you will receive a New Patient Homeopathic Questionnaire by email.

This is a detailed questionnaire for you to begin the process of homeopathy. The questionnaire invites you to fill in details of your physical health, emotional wellbeing, history of medications, family health history and your timeline - key life events which have influenced your health and wellbeing. All information shared is held in confidentiality, and the questionnaire is used as the starting point for your Initial Consultation with Clare. Have a read through and fill in what feels relevant for you.

Physical Health Questions

Holistic Homeopathy with Clare is all about understanding you as an individual - time is taken to understand the challenges, symptoms and issues you may be experiencing with your health, as well as understanding where you are feeling well and balanced. The physical health questions are a starting point for understanding how your physical body is working - what is working well, where you may be struggling, and what is normal for you.

The physical health section of the questionnaire is very comprehensive and asks questions about the following - just answer what is relevant to you:

• Family medical history

• Past and present medications and immunisations

• Allergies

• Muscular-skeletal issues, joints, muscles, pain, previous injuries

• Hair, scalp and skin issues including any eczema, rashes, allergies, warts

• Headaches or migraines - including what triggers these and what makes them better

• Eye, ear and throat issues - including tinnitus, infections, history of glandular fever, hayfever

• Mouth and teeth including ulcers, gums, history of dental work

• Chest - including lungs, breathing, asthma, allergies and any heart, breast and blood pressure issues

• Digestive system - including liver, stomach, bowel and appetite issues, food allergies

• Kidney, bladder, urinary and genital issues - issues with urination, kidney infections

• Menstrual cycle, female hormones, issues with fertility, pregnancy, birth, perimenopause, menopause, hormonal contraceptives

• Sleep - issues with falling asleep, night waking, dreams

• Diet - appetite, typical foods and drink, alcohol, previous recreational drug use, smoking, appetite cravings and aversions

• Typical exercise and energy levels.
  
  This section is a starting point to list the areas of your body that you feel are working well, and the areas and aspects where you would like support. Then in your initial consultation Clare will ask you in more detail about the history of any physical conditions and how you experience these now, including questions about when you experience symptoms, and what makes things worse and what makes things better. Don't be put off by the long list of questions! Just answer what is relevant to you.

Mind and emotions questions

The next part of the questionnaire invites you to share about yourself as a person, including more details about the way you think, things that worry you, and your emotions. The mind and emotions questions explore the following - again only answer what is relevant to you:

• Describe yourself as a person - what are you like? What do you enjoy or dislike

• Details of any fears, phobias or anxieties - many people use homeopathy to deal with phobias and anxieties

• Details of your experiences with anger, frustration, grief and sadness - what causes you to feel these emotions? How do you express them? What makes you feel better?

• Where do you like to be? Are you tidy or messy? What causes you stress?

For many people the homeopathic consultation can be a really welcome space to talk about difficult feelings, and remedies and flower essences can support with emotional healing. Unexpressed emotions, emotional shocks and emotional stresses can have an impact on our physical health. The homeopathic consultation offers a space to talk about past or current issues in the context of your overall health, and Clare will prescribe remedies and essences to support you across your mental and emotional landscapes as well as any physcial issues.

your timeline - the story of your life

The final part of the questionnaire is your Timeline - taking the timeline is a key part of working with a homeopath and is your opportunity to reflect on the events of your life and how you felt about things - both in the past and in the present. This Timeline section invites you to reflect and note down key memories from your past and how you felt about them - we will then be able to talk through your life history in more detail in your consultations. Reflecting and exploring your life history helps to understand the context of your health journey and understand potential roots and causes of health issues you may be experiencing now.

For example many people recall eczema beginning in childhood and using many different creams and treatments to address this. In your consultation we will explore what you remember about your journey with eczema - when it started, where it came up, what treatments you used, what caused it to flare up or settle down - and then homeopathic remedies will be prescribed to detox any past medications where necessary, and treat the symptoms of eczema as experienced by you as an individual.

WHAT IF I FIND WRITING DIFFICULT? DO I HAVE TO COMPLETE THE FORM?

The simple answer is no! One of the key elements of working with Clare for homeopathy and yoga is the importance of listening to your own body and energy and doing what is right and most aligned for you. If you do not feel able to fill in the questionnaire, if you are dyslexic or struggle with or dislike writing or computers - then you are welcome to either fill in as much of the form as you like, to send some information over to Clare in an email, or to leave the form altogether and we will talk everything through in your appointment.

On the other hand, if you find it helpful to express yourself through writing - you are welcome to complete the form in as much detail as you like, and use this as a space for reflections on your health and healing journey.

DISCLAIMER: This article and all content on this website is for educational purposes only and does not constitute medical advice or replace advice received from your doctor or qualified health professional. Always seek the guidance of your doctor or other qualified medical professional with any questions you may have regarding your health or any medical condition. If you think you may have a medical emergency, call 999 / 111 or go to your doctor or nearest accident and emergency facility and follow the advice of medical professionals.

Clare Cooper Holistic Homeopath is the sole owner of all content on this website which is provided for educational purposes only and does not constitute or replace medical advice.