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COMPUTER HOMOEOPATHY CONSULTANT

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GENERAL QUESTIONNAIRE

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Age :   Sex :
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Note : Read the questionnaire in detail and reply all the questions correctly because the selection of medicine depends upon the reply given by you.

1. What is the problem? For how long have you been suffering from this problem? Have you taken any medicine (homoeopathy, allopathy or ayurvedic), if yes, then which and for how long? Write in detail.

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2. When did you first experience this problem? Is there any specific reason or an event behind this problem or is there a family history of this disease?

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3. How much anger do you experience? For how long you remain in a fit of anger? What do you do during the time you are angry? Do you repent for later on? If yes, after what period of time do you repent?

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4. Are you health conscious or do you eat whatever you like irrespective of whether it is good for your health or not?

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5. Do you willingly go in for medical tests or are you afraid of them? If there is any fear then what is the reason behind it?

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6. Do you like watching television, listening to music, or do you switch it off and feel palpitation on hearing music etc?

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7. What do you feel like doing when you experience the problem? Do you want to take rest or keep on doing your work?

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8. Are you particular about performing your duties? Or are you burdened with responsibilities or relatively free?

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9. How often and in what amount you take alcoholic drinks? Do you believe in having sex with multiple partners or with your spouse only? Do you enjoy sex or have aversion to it?

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10. How much do you care about your family members, friends and others in contact with you?

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11. What do you think about your recovery? (Doubtful, hopeful or hopelessness)

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12. Fear, phobias or anxiety of any kind?

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13. Do you get tense before any event like exams, meeting someone, going to some place etc.? Do you do things in a hurry? Please specify.

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14. Do you feel like ending your life in case you are very depressed? Why and how?

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15. Are you talkative or like to remain quiet?

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16. Do you cry easily and what are the things that make you cry?

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17. Do you like sympathy?

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18. What are your ambitions in life? What have you achieved so far?

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19. Are you dominating and dictatorial?

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20. Are you satisfied with your life or there are some deficiencies? Are you optimistic or pessimistic?

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21. Any other problem or event you want to share?

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