CAROL ANNE RAYSON

CAROL ANNE RAYSON
DCHM(Hons.), HD(RHom.), RHN, Certified CEASE Therapist

Personalized Homeopathic Care For People & Their Pets

"CARPE DIEM"

INTAKE FORM COMPLETION & SYMPTOM REPORTING

GUIDELINES FOR COMPLETING INTAKE FORMS & REPORTING SYMPTOMS
Researched & Written by Carol Anne Rayson, DCHM (Hons),HD (RHom.), RHN,CLASSICAL HOMEOPATH, Certified CEASE Therapist

In order to select the best-suited Remedy, I need to examine not only all the Objective & Subjective, Physiological and Psychological Symptoms which you are experiencing now, but I also must consider any acute or chronic conditions, surgeries, accidents and emotional traumas of your past. Therefore, it is essential that you fill out your Intake Form as completely and as in-depth as is possible. If you have any queries when doing so this, please contact me, or leave that Section blank and we will then discuss during our Consultation. Your First Consultation will take up to 2 hours, in order for me to obtain a complete picture of the Totality of all your symptoms. Follow-ups last approximately 30-45 minutes.

Please be assured that ALL the information you provide, both orally and written, is kept in the strictest confidence-according to the Laws which govern Homeopathic Patient Confidentiality.

Reporting Symptoms to your Homeopath, requires observation and the detailing of the important Modalities involved in individual expressions of altered states of health.

Modalities are the Symptom-Language of each individual body: the factors which make Symptoms
Better or Worse, and those factors usually differ from individual to individual.

Below I have included a list of the most pertinent Modalities for you to consider.

Please take detailed notes about your particular Symptom Modalities for each Homeopathic Consultation & Follow-up, noting any changes or differences in Modalities or any new Modalities, as compared to previous visits.

TIME: Specific times or general times of the day, week month, year or season. Phases of the moon; Noted Periodicity such as during, before or after Menes.

ENVIRONMENT: Rain; Humidity; Dampness; Snow; Wind; Fog; Thunderstorms; Overcast; Sunshine; Country/City/Seashore; Outdoors/Indoors

MOTION: Better or worse First Movement; better or worse from Rest/Prolonged Movement; Gentle or Vigorous exercise; Climbing or Descending Stairs; Walking /Running; Changing position in bed; Bending over; Stretching; Rising from chair or bed.

POSITION: Sitting; Lying in various positions; Lying on painful or non-painful side; Sleep Position; Standing.

BODILY FUNCTIONS: Before, after & during sleep; Perspiration; Urinary; Bowels; Gas; Sexual activity; Before, after & during Eating and Drinking; Burping/ Sneezing/Coughing. Before, during and after Menses; Pregnancy; Menopause.

SENSORY: Odors; Noises; Touch; Wool; Music; Artificial light; Darkness; Pressure-Firm or soft; Constriction; Tight Clothing; Hats.

PSYCHOLOGICAL: Fears; Insecurities; Shock; Grief; Loss; Excitement; Anticipation; Suppression; Memories; Dreams; Overwork; Studying; Relationships.

BODY LOCATIONS: Right or Left sides, Front or Back of head; Moving from one side to the other; Changeable;
Moving Downwards or Upwards; Specific Body Parts; Feet/Hands/Head.

SPECIFIC FOODS & BEVERAGES: Hot and Cold drinks; Sweets; Sour; Salty; Coffee; Alcohol; Chocolate; Spices; Fruit; Fish; Cheese; Dairy; Eggs; Farinaceous; Potatoes; Bread; Butter; Fat; Pork/Bacon.