Online Homeopathic Consultation Form

1. Personal Details

First Name(s) *

Surname *

Address Line 1

Address Line 2

City / State

Post Code / Zip

Country

Telephone No.

Email *

Age

Date of Birth

Gender

Height

Weight (unclothed)

Marital Status

Number of Children

Please describe what you look like, e.g. typical clothes and expression? (It may also be helpful if you email me a photo).

Are you working and if so what do you do?

2. Terms & Conditions

Please click here to read the Terms & Conditions

Terms & Conditions

The following 14 terms and conditions apply to the use of this site

When you enter Homeopathy Helpline web site you acknowledge and agree to be bound by the terms and conditions of the site. These terms and conditions may be modified from time to time at the sole discretion of Francis Treuherz Registered Homeopath. Each time you access this web site you will be deemed to have accepted any such changes.
Entry to and use of Homeopathy Helpline web site is entirely at your own risk.
The content of the Homeopathy Helpline web site and the content of any personal messages is available for personal non-commercial use only.
Francis Treuherz holds the copyright to the work. The work is property which is protected by copyright and other intellectual property laws. Users may not exploit any part of the content in any way without the written permission of the copyright owner.
Francis Treuherz reserves editorial rights over any material submitted for inclusion in Homeopathy Helpline. Such material will be included solely at the discretion of Francis Treuherz and then only in good faith and without representation as to its accuracy.
Francis Treuherz assumes no responsibility for the contents of any other web sites to which Homeopathy Helpline web site has links. Such links are provided for information and convenience only and do not imply endorsement of material on any other site. Any 'recommendation' is based upon the general description of the site owner and not on a detailed consideration of the site content. All liability with regard to your access of such linked web sites is disclaimed.
While Francis Treuherz takes reasonable care to compile accurate information and keep it up-to-date, the correctness and completeness of this quantity of information cannot be guaranteed. Subject to any liability which may not be excluded by law, Francis Treuherz is not responsible for any loss, damage or expense resulting from the use of any information contained in this web site.
The content of Homeopathy Helpline web site is subject to change without notice at the editorial discretion of Francis Treuherz.
Uninterrupted access to this web site or the sites to which it links cannot be guaranteed. Francis Treuherz cannot accept responsibility for any damage arising from loss of use of this information.
As a user you acknowledge that information contained within the Homeopathy Helpline web site is not intended to be nor is to be treated as a substitute for professional medical advice relative to a specific medical condition or question. The therapeutic procedures in this site are based on the training and personal experiences and research of Francis Treuherz. Because each person and situation is unique, you are urged to check with a qualified health professional before using remedy or procedure when there is any question regarding the presence or treatment of any health condition. Because there is always some risk involved Francis Treuherz is not responsible for any adverse effects or consequences resulting from the use of any suggestions, preparations, or procedures described in this web site. Please do not use this web site if you are unwilling to assume the risk. Feel free to consult with a physician or other qualified health professional. It is a sign of wisdom, not cowardice to seek a second or third opinion.
This legal statement and the disclaimers and exclusions contained within it shall be governed in accordance with English law and subject to the jurisdiction of the courts of England and Wales.
If any one or part of these conditions is held to be invalid the remainder will continue to have effect.
If you access Homeopathy Helpline from outside the UK it is your responsibility to ensure the suitability and legality of any medicines purchased for use in your area.
If you have any comments or suggestions about Homeopathy Helpline web site please contact us.

I accept the Terms & Conditions *

3. Reason for Visit

It's now time for you to outline what's troubling you.

Please be prepared to spend at least an hour working on the questionnaire. And then I shall be spending probably at least an hour studying it, and analysing the information. This is what takes up my time, and this is the knowledge, skill and experience for which you will be paying me. An online consultation is the equivalent of being in the consulting room for a one hour session.

Questions and Answers

You can fill out the questionnaire in detail using the answer boxes, or use it as a memory aid and tell me your story in your own words in the form of a letter if you wish.

When completing the questionnaire, it is important to fill in all the sections that are appropriate for you and give me all the information required so that I can plan your treatment accordingly. All the information is confidential, so please answer all questions as fully as you can.

After the receipt of this information I will assess your case and establish a suitable homeopathic course of treatment. If necessary I may email you with a list of further questions before your treatment is finalised in order to clarify any uncertain points.

Prescriptions

Once I have finished studying your case, and I shall give you all the information you will need. I can send you a detailed prescription via email and you can order the remedy yourself. Remedies may be obtained from Ainsworths or Helios in England, or Freemans in Scotland, or from a pharmacy in your own country, for example Washington Homeopathic products in the USA. If you want advice about obtaining the remedies please let me know. This will include any necessary supplementary information as appropriate and general advice regarding the do's and don'ts during your homeopathic treatment. Most of this is in the introductory page.

Please complete the following questions and tell me some more details so I can help you.

I would like to begin with you telling me in your own words what has brought you here today. Please be as general or specific as you wish.

I often ask my patients "And what have you been up to?" or "How can homeopathy help you?". So if you wish just sit back, relax, and write about yourself.

If you prefer, you may answer the questions that follow and come back to this question later. The questions are designed to jog your memory and show you what I need to understand about you.

What is your reason for consulting me today?

4. Current Symptoms

Please try and describe all the current symptoms in your own words including if possible, the cause. To help you with your response, imagine that you are sitting in front of me and I ask, "So what brings you here today?"

When did the symptoms begin? Can you suggest some factors that helped create these symptoms?

If this is not the first occurrence please describe any previous problems of this kind.

Please describe anything that you feel is associated with the current symptoms that is unusual, rare and/or peculiar or any other information which you wish to add.

It would also be very useful if you could describe any particular important events in your life. How did you feel about them at the time? Also, how you feel about them now?

5. General Symptoms

I am interested in what makes your body tick in general. For example, if you have cold feet that is a particular symptom, and is useful to me. Similarly, if you are always worse from cold or seem to lack vital heat that is a general symptom, and a small clue for me.

By answering as many of these questions as fully as possible, you are helping me interpret what your body and unconscious mind are doing, so that I can find a remedy for you.

In which season do you feel less well?

How does fog affect you?

At what time during the day or night do you feel worst?

How do you stand the cold / hot / dry / wet weather?

What do you feel when exposed to the sun?

How does change of weather affect you? What about snow?

What are your reactions to north wind / south wind / the wind in general?

How do you feel before, during and after a storm?

What about warmth in general, warmth of the bed, of the room, of the stove?

What about draughts of air and changes of temperature?

How do you react to extremes of temperature?

What difference do you make in your clothing in winter?

What position do you like best (Sitting / Standing / Lying)?

What about taking colds in winter and in other seasons?

How do you feel standing or kneeling in a church / mosque / synagogue / temple or other place of worship or meditation?

What kind of climate is objectionable to you, and where would you choose to spend your vacation?

How do you keep your window at night?

6. General Symptoms (continued)

We need to fill out your story with answers to whichever of the following questions are relevant to you. These questions are based on those used by Dr Pierre Schmidt, an eminent Swiss homeopathic physician who wrote on the art of taking cases.

What sports do you play?

How do you feel riding in cars or sailing?

How do you feel before / during / after meals?

What about your appetite, how do you feel if you go without a meal?

What do you drink and in what quantity? What about thirst?

What are the foods that make you sick and why?

What about wine / beer / coffee / tea / milk / vinegar?

How much do you smoke in a day? How do you feel after smoking?

Are there any drugs which you are very sensitive too or which make you sick?

What are the vaccinations you have had and the results from them?

What about cold or warm baths, or sea baths?

How do you feel at the seaside or on high mountains?

How do collars, belts and tight clothing affect you?

How long do your wounds take to heal, how long do they bleed for?

In what circumstances have you felt like fainting?

7. Mental and Emotional Symptoms

The symptoms of the Mind are most important and should be carefully considered. Try to give all these symptoms fully as they are very important.

Please note that the questions and language here used are merely suggestive, and are simply intended to lead you to give all your symptoms.

What are the greatest griefs that you have gone through in your life?

What are the greatest joys you have had in life?

In what circumstances have you ever felt jealous?

On what occasions do you weep? At music? At reproaches? At what time of day?

How do you cope with your worries?

What effect does consolation have on you?

On what occasions do you feel despair?

How do you stand waiting?

When and on what occasions do you feel frightened or anxious?

How do you feel in a room full of people or at church, etc or at a lecture?

Do you go red or white when you are angry and how do you feel afterwards?

How rapidly do you walk or eat or talk or write?

What have been the complaints or effects following chagrin, grief, disappointed, love, vexation, mortification, indignation, bad news, fright?

Tell me all about over-conscientiousness and over-scrupulousness, about trifles; some people do not care about too much details and too much order.

What about your memory? Your understanding? Your will? Your concentration? Any tendency to make mistakes?

At what time in the twenty-four hours do you feel the blues, depressed, sad, pessimistic?

In time of depression, how do you look at death?

8. Food and Sleep

I am looking for clues about you. For example, along with your sleeping patterns I am interested in what you like to eat.

Once a patient said she was hungry in my rooms, and asked if I minded if she ate a snack. I said fine of course. So she took out a tin of Tuna fish and a fork, and ate the contents of the tin. Then she took out another and ate that.

The result of this clue was a diagnosis of a complex endocrine problem, of iron and calcium and iodine, and I knew her remedy. So be sure to tell me what the regular medical people will ignore or scoff at.

What is the kind of food for which you have a marked craving or aversion for?

What kind of food makes you sick or you are unable to eat?

What about pastry and sweets?

What about sour or spiced food?

What about rich or greasy food?

What about thirst and what do you drink?

How much salt do you need for your taste?

Do you have a 'salt tooth', e.g. do you add salt to food at the table?

Do you drink coffee / tea / wine / beer or other?

In which position do you sleep? How long have you slept in that position?

Where do you put your arms, and how do you like to have your head?

At what time do you wake up and how do you feel?

When are you sleepy?

What makes you restless or sleepy?

What about dreams?

What do you do during sleep? Talk? Laugh? Cry out? Weep? Be restless? Be afraid? Grind your teeth? Have your mouth open? Have your eyes open?

9. For Women Only

These questions may appear rather intimate. The answers will help me understand what is troubling you and how to help you. I do not accept the idea that menstrual troubles are something with which you have to live. Many women are told that nothing can be done. I am an optimist and I hope that something can be done, so please answer what you feel are relevant questions.

At what age did your periods begin?

How frequently do your periods come?

Please describe their duration, abundance, colour, odour.

Please describe any other significant details that may be relevant.

At what time in the twenty-four hours do they flow most?

How do you feel before, during and after your period?

What about your character, feelings, or behaviour before, during and after your period?

10. Bodily Functions and Discharges

In all of these questions, I am interested in the sensations, their location, what modifies them and what accompanies them.

Skin symptoms need to be described as I cannot see them. Are they dry, moist, oozing? What is the nature of the discharge? Where did they start, and in which part of your body? And when - after a vaccination or after a grief? When do they come and go?

Please detail what is normal and what is unusual or troubling for you in relation to temperature, sweat, mucous, smells, bowels, urine and genital functions?

Any problems of the senses, hearing, vision, smell, taste?

Do you have any problems in your mouth or dental problems?

Do you have any skin problems like eczema, warts, tumours, psoriasis or unexplained eruptions?

Has a diagnosis been made for any condition? If so by whom, what is it, detail any advice given?

Are you taking any homeopathic remedy, conventional medication, herb, vitamin or mineral supplement?

Do you take any exercise?

In case you did not mention it above, do you feel any pain?

Is the pain you feel burning, aching, numbness and/or throbbing or other sensation. Provide any other information?

Complete the sentence, 'It feels as if...' about all your pains or discomforts.

11. Your Personal History

In all of these questions, I am interested in the sensations, their location, what modifies them and what accompanies them.

Please detail you medical history since childhood as far as you can recall, including accidents, time in hospital etc.

Please provide as much information as you can regarding the medical history of your immediate family and grandparents.

Can you describe your home circumstances and important relationships?

What are your passions and leisure pursuits?

Are their important aspects of your life that have not been covered?

Thank you for completing the questionnaire. Please click Submit to proceed to the payment screens.

Note you will be taken back to this page if there are any errors in your form.

Dedicated to delivering individual solutions to your health problems using homeopathy. since 1984