CAROL ANNE RAYSON|
DCHM(Hons.), HD(RHom.), RHN, Certified CEASE Therapist
Care For People & Their Pets
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
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
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;
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;
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.
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.
Carol Anne Rayson 2011|