Case Taking – THE HEALER

Homeopathic Case-Taking Form

Homeopathic Case-Taking Form

Full Name:

Age:

Gender:

Occupation:

Primary Complaint:

Secondary Complaints:

Past Medical History:

Family Medical History:

Dietary Habits:

Exercise and Physical Activity:

Lifestyle and Habits (e.g., smoking, alcohol):

Symptom Modalities (what worsens or improves symptoms):

Characteristics of Symptoms (e.g., sharp, dull):

Menstrual/Reproductive History (if applicable):