Occupation of Parents (Nature of Work)
Address of Work Place
Details of present illness
In Homoepathy, prescription is based on precise details of various complaints that the child has, mere
mention of a complaint does not suffice for a good prescription. Please follow the instructions given below
for helping us understand your child’s complaints.
We require the following details about your child’s symptom.
Part & Family History
Information about child's siblings
At what age did the child start
Appetite and Thirst
Urination & Urine
Sweat / Perspiration - Fever - Chill
Sensitivity to heat and cold
Sexual Sphere (General)
In order to understand you we will be asking certain questions. Answer them freely, carefully and completely.
This information will help us much in giving you the correct remedy. Also such a remedy will help improve
your mental make up.
Answer freely. Answer frankly. Answer completely.
Parts of body affected
Mother's history during pregnancy
Any change your observed in your general pattern of