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Homeopathic Acute Care By Email: $50 Flat Rate
$50 for Monday - Friday requests, $75 for Saturday - Sunday requests.
Flat rate includes 7 consecutive days Acute Care by email and is provided for any location in the USA.

For any condition lasting more than 30 days, request Chronic Care

For urgent or life-threatening illness or injury,
call your medical doctor or 911.

  • Medical insurance does not cover our homeopathic services.

  • Acute Care consultations by email are billed at a $50.00 flat rate per acute, per person.  If your Acute request arrives after Friday at 5 pm (PST) and before Monday at 9 am (PST) the fee is $75.00 flat rate fee per acute, per person for WEEKEND ACUTE CARE.

  • You will be required to pay in advance in Paypal before Acute Care is provided. Follow the link provided on your confirmation screen after submission of our symptoms.

  • Acute Care fee covers and specifically includes: initial case analysis, prescribing the remedy(ies) needed during this acute, all email correspondence specifically related to this acute, email follow-ups as needed on a DAILY basis until this specific acute is handled OR up to 7 days, whichever comes first.

  • All Clients (or their parent if a child) will be expected to report by email about 1 time daily during acute care or as instructed to determine a remedy's effectiveness and/or prescribe a new potency, frequency of dosing or remedy.

  • Your Acute Care Fee does not include the cost of any remedy(ies) that are prescribed.  It is the client's responsibility to obtain the remedies prescribed.  Dry remedies in a remedy packet of 6 - 8 pills can be ordered from us for $10.00 per remedy, including mailing in the USA.  Express mail shipping and handling is an extra fee.

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ACUTE CLIENTS: ACUTE SYMPTOMS FORM

The information about acute symptoms that you provide and in the detail requested will give us the specific information needed to RAPIDLY prescribe a well matched homeopathic remedy.

A remedy prescription and dosing instructions will be emailed to you as soon as possible after your payment in Paypal has been received. 

You will receive a copy of all symptoms submitted and other instructions about homeopathic care by email immediately after submission of this form.

Submit 1 form per person, per acute injury or illness.

ACUTE CLIENT INFORMATION

First and Last Name
Your Email
check accuracy!

Check for accuracy! This form will only submit with a valid email address.
Name of Person for acute care
Age of Person for acute care
Your Complete Mailing Address:
Include all: Address, City, State, Zip Code.
Phone(s)
Please provide your home, work, and/or cell phones.
Skype address
If none, write N/A. 
Best Time(s) To Call
Please provide best times to call, if we need to reach you by phone.
Have you ever used homeopathy before?
If YES, please give the NAME of your most recent Homeopath below.

If NO, write N/A.

TYPE OF ACUTE

What is the GENERAL LOCATION of where this current acute is located?

Select one LOCATION that is the best match for the major issue and it's symptoms.

What is the KEY ISSUE for this acute?

Select only one ISSUE that is the best match.

Please briefly describe this acute.

ONSET OF THIS ACUTE

Onset of this Acute

Select only one for ONSET.

What happen JUST BEFORE this acute began? Describe what happened briefly just PRIOR to this acute if an illness.
For example,
was there any change in weather? Sleep?  Exposure to sick family members? Other illness?  Emotional trauma? Physical trauma? Include the types of circumstances involving the mind and the emotions.

Briefly write about what you think might be a "Trigger" Event that happened in the last 24 hours up to one week prior to this acute.

MENTAL/EMOTIONAL SYMPTOMS

Mental and Emotional Symptoms

 

Has the person's CURRENT STATE OF MIND OR EMOTIONS changed from how they usually are? Select only one.

What is the general state of MIND OR EMOTIONS of the person now?
Select only one that is the best match.

Add details needed to clarify the CURRENT STATE OF MIND.  Include if there are CHANGES in the general mood from the normal mood with this acute.

If none, write N/A.

ENERGY LEVEL

Describe current ENERGY level Select only one for ENERGY LEVEL.

FEVER OR CHILLS

Is a FEVER or are CHILLS present right now? Select only one for FEVER OR CHILLS.  Report is what the body temperature is NOW.

If there were FEVER or CHILLS present in the last 48 hours, give the actual temperature now or write about any chills.

If none, write N/A.

THIRST

How THIRSTY is the person now? Select only one for THIRST.

PERSPIRATION

Describe the PERSPIRATION.

Select only one on for PERSPIRATION.

COUGH

Is a COUGH present? Select only one for COUGH.


What type of cough best describes it?
Select only one.

If there is EXPECTORANT with the cough, describe the color such as clear, white, yellowish, greenish, bloody, etc.

If none, write N/A.

NOSE MUCUS

Is NOSE MUCUS present? Select only one for NOSE MUCUS.


What is the COLOR AND CONSISTENCY of the nose mucus?
Select only one that best describes it.

THROAT

Is a SORE THROAT present? Select only one for THROAT.

What SIDE of the throat is affected?
Select only one.

STOMACH

Are there any issues with STOMACH? Select only one for STOMACH.

Describe any current STOMACH issues below.  Include any changes in food desires, food aversions, any discomfort, any VOMITING and how often, etc.

If none, write N/A.

STOOL

Are there any issues with STOOL? Select only one for STOOL.

Describe any current STOOL related issues below.  Include if any DIARRHEA, LOOSE STOOL or CHANGES IN STOOL for this acute.  If STOOL has changed describe the frequency, color, consistency and odor. 

If none, write N/A.

SKIN

Are there any SKIN issues present? Select only one for SKIN.

Describe any SKIN issues below.  Include color discoloration such as red cheeks, red ears, pale, etc.  Describe how it looks, any dryness, if itching.  Tell what makes it feel better or worse, etc.

If none, write N/A.

SIDE OF BODY AFFECTED

What SIDE of the body in general is most affected?

Select only one for SIDE AFFECTED.

TIME  KEY SYMPTOMS ARE BETTER

What time of day are the symptoms BETTER?

When are the key symptoms BETTER? (
Select only one.

TIME KEY SYMPTOMS ARE WORSE

What time of day are the symptoms WORSE

When are symptoms WORSE?
Select only one.

Time When Feeling Better or Worse

Describe any TIME OF DAY issues below regarding when a symptom or set of symptoms are BETTER or WORSE.

If none, write N/A.

WHAT MAKES THE KEY SYMPTOMS FEEL BETTER?

What makes the person and/or the symptom feel BETTER?

 

This is one of the most  important questions to selecting the right remedy!

WHAT MAKES THE MAIN ISSUE FEEL BETTER (ameliorates)?

BETTER WITH: being held, being quiet, being left alone, fresh air, dark room, fresh air, lying still, rest, sleep, movement, etc.

Heat: hot applications, warm drinks, blankets, warm drinks, etc.

Cold: cold applications, cold drinks.

Food:  eating, not eating, etc.

If so, describe using items above and others that apply.  If none, write N/A.

WHAT MAKES THE KEY SYMPTOMS WORSE?

What makes the person and/or symptom feel WORSE? This is one of the most important questions to selecting the right remedy!

WHAT MAKES THE MAIN ISSUE WORSE? (aggravates).

WORSE WITH: noise, exertion, movement, lying down, sitting, standing, sunlight, touch, pressure, no pressure,  etc.

Heat: hot applications, warm drinks, blankets, warm drinks, etc.

Cold: cold applications, cold drinks, etc.

Food:  eating, not eating, etc.

If so, describe using items above and others that apply.  If none, write N/A.

EXTENSIONS

Does the pain or discomfort EXTEND to any other part of the body?

Give any EXTENSIONS FOR MAIN ISSUE.

For example: pain from the left to the right, from the top to bottom, from the head to the neck, from the shoulder to the back, etc.

If so, describe.  If none, write N/A.

SENSATION

Are there any SENSATIONS that describe the feeling, pain, etc. of this acute? Give the primary SENSATION FOR THE MAIN ISSUE.

If the sensation for the primary issue is not in this list, please write it below.  If none, write N/A.

UNUSUAL, STRANGE, RARE OR PECULIAR SYMPTOMS

Are there any UNUSUAL, STRANGE, RARE or PECULIAR (SRP) symptoms present now? This is one of the most  important questions to selecting the right remedy!

Include any UNUSUAL, STRANGE, RARE OR PECULIAR SYMPTOMS FOR THIS PERSON. This would be things rarely or never seen  that appear now with this acute.  Include things like strong changes in emotions, stool and color changes, unusual food desires, unusual tastes,  sounds heard differently, strange noises made, uncontrolled body movements, skin discolorations, strange behaviors, etc.

If so, describe.  If none, write N/A.

OTHER TREATMENT SO FAR?

What other TREATMENT was given for this acute? Include any OTHER TREATMENT being done now.

HOMEOPATHIC REMEDIES TAKEN:
a. Include all homeopathy taken for this acute and/or in the last 7 days.
b.  Give the potency per remedy.
c. Give doses per remedy and if wet or dry.
OTHER MEDICATIONS:
Include any over the counter OR prescription medication that was taken for this acute in the last 7 days.

ADDITIONAL COMMENTS

Please add any other COMMENTS here.

Include any other COMMENTS here.

If none, write N/A.

How did you find out about Homeopathy For Women?

Select only one.

Were you  REFERRED to us?

If you are a REFERRAL, please give the name of the person who referred you.

If not, write N/A.

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Your information is always kept private and confidential.

By submitting this Form, you give Homeopathy for Women, it's Director and/or any of its Associated Homeopaths permission to contact you by phone, skype and/or email.  You will be contacted as promptly as possible.

A confirmation screen will appear after your successful submission for you to make your Paypal payment.

You will also immediately receive a confirmation email with specific additional instructions sent to the email address used in this form.

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Please submit only once.

Thank you!

This Acute Care Form is copyrighted 2009 - 2010 by Homeopathy For Women. 
All rights reserved.  No part of this Form or the on-line reporting system may be copied, reproduced digitally or in print without our written permission.

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