Intake Forms

Taking a patient's initial case is essentially a conversation where the homeopath's primary job is to listen to that person describe in her own words why she needs medical help. The client is the pilot; the practitioner is the navigator. Before this happens, the client fills out an intake form which is a questionnaire to provide mostly general information. The following two forms will give the reader an idea of the the kind of information that I will be looking for in order to match your case with an appropriate remedy. In general, the initial interview takes approximately two hours.

"In their treatments, the physicians of the old school made it extremely easy for themselves in this regard. They made no exact inquiry about all of the patient's circumstances. Indeed, the physician often interrupted patients in the account of their individual ailments in order not to be disturbed in the rapid writing up of the prescription..." (Samuel Hahnemann, Organon of the Medical Art, footnote to aphorism 104)

What follows is two intake forms, one for adults and one for children. Please use a separate sheet of paper to answer the questions. It is not recommended that you send sensitive, confidential information via e-mail. My web server and personal computer have security measures but no internet traffic is secure. It would be much better for my peace of mind, and yours, if you used my mailing address instead.

Adult Intake
Child Intake