HUSSAIN KAISRANI
(For Appointment WhatsApp text or voice message: +92 300 2000210)
Instructions for Written Submission
Introduction
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To find the right homeopathic remedy for your child, we need detailed information about: - 
Main and other complaints 
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The child’s personality and overall health 
 
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Please provide complete information. Nothing should be left out, even if it seems unimportant. This helps us make the best decision. All information is confidential. 
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This process takes time. A specially assigned physician will review your information before treatment starts. Sometimes more time or another appointment may be needed. 
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Your full cooperation is appreciated to help us serve you best. 
Child’s Basic Information
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Full name 
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Address and phone number 
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Date of birth 
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Gender 
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Religion / Community / Sect 
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School and class 
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Diet (vegetarian, non-vegetarian, eggs) 
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Habits (tea, coffee, milk, chocolates, etc.) 
Family Details
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List all family members, their ages, occupations, where they live, and how they relate to the child 
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Note any deceased relatives with age, year, and cause of death 
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Mention if parents are related by blood (consanguineous marriage) 
Daily Routine
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Describe the child’s typical day from waking up to bedtime 
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Include details of meals and quantities 
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Time spent on studies and play 
Main Complaint
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Describe the primary problem bothering the child 
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How long has it lasted? 
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What helps or worsens it? 
Other Complaints
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List other current or past problems 
Personal Details
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Physical description (appearance, build, etc.) 
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Emotional nature (anger, fears, shyness, attachments, recent changes) 
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Intellectual abilities (school performance, hobbies, activities) 
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Relationships with family, friends, teachers, and any difficulties 
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Any family financial or personal stresses 
Reactions to Environment
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Food likes, dislikes, cravings (chalk, earth, etc.) 
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Reaction to weather, temperature, bath, clothing 
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Sleep habits and dreams 
Growth and Development
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Type of delivery and birth weight 
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Health after birth 
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Mother’s health and emotions during pregnancy and after birth 
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Breastfeeding details 
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Medicines taken during pregnancy 
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Vaccination history 
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Milestones: teething, sitting, walking, talking, toilet training 
Past Illnesses
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Summary of illnesses and how they relate to current issues 
Family Medical History
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Health of parents, siblings, grandparents, and other relatives 
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Any chronic illnesses or conditions 
Additional Comments
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Anything else you think is important 
Documents to Attach
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Referral letter (if any) 
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Previous medical records 
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Lab reports 
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X-rays, scans, etc. 
Thank you for providing this information. It will help us give the best care possible for your child.
