Introduction
To choose the best homeopathic remedy for your child, we need detailed information. Please answer as fully as possible. All details are private and will only be used for your child’s care.
We especially need information on:
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Main and other health or behaviour concerns
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Personality, emotions, habits, and daily routine
1. Basic Information
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Child’s name, date of birth, gender
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Address & phone number
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Religion (optional)
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School & current grade
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Food choice (Vegetarian / Non-Vegetarian / Eggs)
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Eating & drinking habits (tea, coffee, milk, chocolate, etc.)
2. Family Background
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Parents’ names & jobs
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Brothers / sisters (age, school, health)
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Other family members at home
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Relationship with each family member
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Any family history of medical or mental health conditions
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Were parents related before marriage (cousins)?
3. Daily Routine
Describe your child’s usual day (wake-up, meals, naps, bedtime, screen use, hobbies, play, schoolwork, etc.).
4. Main Concerns
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What troubles your child most? Since when?
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How often does it happen?
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What makes it better or worse?
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How does it affect daily life?
5. Other Concerns
Any other health, behaviour, or emotional issues (past or present).
6. Personal & Behaviour Information
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Physical: Height, weight, posture, appearance
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Emotions & behaviour: Anger, fears, attachments, shyness, changes
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Learning & skills: School work, concentration, hobbies, special interests
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Social life: Family, friends, teachers, difficulties if any
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Environment: Sensitivity to heat, cold, clothes, bathing, weather
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Food: Likes, dislikes, unusual cravings (chalk, earth, etc.)
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Sleep: Sleep quality, timing, dreams
7. Growth & Development
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Type of birth (normal, caesarean, complications)
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Birth weight, early health
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Mother’s health during pregnancy (body & mind)
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Medicines or stress during pregnancy
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Vaccination history
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Development (teething, sitting, crawling, walking, talking, toilet training)
8. Past Illnesses
List serious illnesses, medicines, infections, hospital stays or surgeries.
9. Family Medical History
Any health conditions in parents, siblings, grandparents, or close relatives (diabetes, blood pressure, heart, asthma, mental health, allergies, TB, hepatitis, headaches, kidney problems, cancer, stomach issues, etc.).
10. Other Notes
Any other important information not listed above.
11. Attachments (if available)
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Doctor’s referral or medical notes
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Old medical records (lab reports, scans, X-rays, assessments)
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School or therapy reports
Closing Note
Thank you for sharing this information. We appreciate your help and assure you that all details will remain private and used only for your child’s care.
