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HOMEOPATHIC QUESTIONNAIRE

Before your homeopathic appointment, you will be provided a detailed questionnaire. This questionnaire is mandatory for homeopathic treatment.

Please plan to bring the completed form to your appointment or mail in advance.

In this video, Leonard Torok, M.D. provides helpful instructions on how to fill out your patient symptom questionnaire.


INSTRUCTIONS

​All symptoms should be graded for their intensity (1 to 10)

  • Leave blank those symptoms that do not occur in your case.
  • Rate symptoms that are mild in your case or occur only infrequently from 1 to 3. These symptoms will only be used in choosing your remedy when they happen to be quite peculiar symptoms. This information may also be useful in the process of eliminating remedies from the list of ones that might match your holistic symptom picture.
  • Give an intensity of 4 to 6 to symptoms that have a moderate intensity or are present fairly often in your case.
  • Give an intensity of 7 to 10 to those symptoms that are strongly expressed in your case or they are present most all of the time.
  • The number rating you give can relate to both the intensity of the symptom itself and the importance of various factors in increasing or decreasing the intensity of a symptom for you. For example, in rating the symptom itching is aggravated at night, if your rash itches greatly at night in bed and not at all during the day, this might be a 9 or 10. If your rash itches much worse at night but also some during the day, you might grade it as 7 or 8.
  • Many of the symptoms listed on the questionnaire include several possibilities or modifying factors. Give the rating number that corresponds to the symptom with the highest intensity and disregard the rest of them. If one symptom is significantly more intense than the others in that set of possible symptoms, underline it on the paper form. This may help us in choosing among possible remedies for your symptoms.
  • Often symptoms that are strange, rare or peculiar symptoms are particularly useful in matching a remedy to your symptoms, even if they occur less intensively or infrequently — e.g. sweat with odor of onions.
  • Symptoms outside of the skin are equally important in picking remedies. All symptoms are rated according to the same criterion of intensity and frequency.
  • There are many pages of symptoms that can occur at times in individual cases of the six diagnoses we have chosen to treat homeopathically. Of course, you will only be expected to have some of the total possible symptoms.

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