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Consultation Form
Take great care  as Homoeopathy is a complex science and accurate replies are vital to ensure correct prescriptions. 
Some of the questions may seem a little unusual, however all of the questions have relevance to a Homoeopathic consultation.
You will receive a response by email within 24 hours (Sundays and weekdays only) and the appropriate homoeopathic remedy or remedies will be dispatched to you together with instructions and advice within the same period by first class post.

Name of patient (if different from payee) 

Gender male    female
Age

        (Please Tick)

Within the past two years, how many times have you suffered with Hay fever?

• None   2 – 4 times   More than 5 times
  throughout the Hay fever season

Which, if any, of the following do you consider best describe your symptoms ?

• streaming, burning nasal discharge starts in the left nostril then moves to the right
• thick honey-coloured nasal discharge comes on after 3 –4 days violent sneezing
• burning throat and irritating cough
• inflamed eyes sensitive to bright light
• burning discharge which irritates the skin under the eyes
• eyes stream with a watery discharge
• sore throat that starts on the left hand side
• dry sore throat, which feels as if there is a lump in it
• violent sneezing
• sore eyes with a cold
• puffy swelling of eyes and throat
• thick yellow discharge
• Is there is a discharge from the nose?   
  If so, does it burn the upper lip?   
  or is it watery?

Do any of the following make your symptoms feel significantly WORSE?

• being in a warm room   warmth
• cold   damp weather
• warm food
• warm drinks   cold drinks
• sneezing
• thought or smell of flowers
• bright light
• being indoors
• in the evening
• after sleep
• at a particular time   yes   no 12.00 am -
  12.00 pm   other

Do any of the following make your symptoms feel significantly BETTER?

• being in cool rooms   fresh air
• warmth
• eating   coffee
• warm drinks
• lying in a darkened room
• cool bathing

Which, if any, of the following symptoms are particularly relevant to you?

• anxiety and worry
• weepy and depressed but want to be alone
• demanding attention/sympathy
• irritability and chilliness of the whole body
• cold sores
• spring and autumn colds or from sudden change in the weather

Press the 'submit' button below to send your consultation and payment. You will receive an acknowledgement within 24 hours (48 if sent on a Saturday). 
A qualified homoeopath will review your form and prescribe appropriate homoeopathic remedies which will be dispatched by first-class post with appropriate instructions.