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Acute Care Request

Homeopathy For Women
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Serving Women, Children & Families in the USA and Canada via convenient Skype Consultations.

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 Acute Care Services

Acute Care is provided in the USA and Canada Only.  An acute issue is something that is a sudden onset.

Homeopathy is NOT Urgent Care! For urgent or life-threatening issues,
call your doctor, medical practitioner or 911 now.

Conditions lasting 30 days are considered chronic care -  request chronic care here instead.

PLEASE READ THIS BEFORE SUBMITTING THE FORM BELOW.

We DO NOT accept new requests if the client has already started any prescription drugs, including steroids, inhalers, antibiotics and/or is currently hospitalized.
Medical insurance does not cover our homeopathic services.

 Acute Care Request are answered Monday - Thursday 9 am - 4 pm (PST).
We will not reply to any requests submitted after business hours,
on all Fridays, weekends or legal holidays.

Returning Acute Care Clients must have access to a 200C remedy kit for care.
Access to Cell Salts is also recommended.

Acute Care Fees - Health Conditions must be 30 days or LESS for acute care.

  • Basic Acute Care: $75 per person, per acute for 7 days of consecutive care.

  • Sport Injury Acute Care: $120 per person, per acute for 7 days of consecutive care.

  • Infectious Disease Acute Care: $150 per person, per acute for 7 days of consecutive care. Infectious acutes specifically include: whooping cough, meningitis, MRSA, pneumonia, staph infections, strep throat and other serious infectious diseases.

  • Care is available for women, men and children by email for short term, non-life threatening illnesses like: fevers, chills, colds, flu, coughs, vomiting, diarrhea, earaches, teething, back pain, sports injuries, etc.

  • Acute care includes the initial acute intake, cases analysis, acute remedy prescription(s) and any required remedy or potency changes during the acute for up to 7 consecutive days.

Extensions to Acute Care

  • Additional acute care requested past 7 days is paid in advance via Paypal at the same rate.

  • Extended Acute Care is available at an additional $75 per week ($120 per week for sports injury, $150 per week for infectious disease care).

  • Acute care may be renewed as needed up to 3 additional weeks.

  • Acute illnesses lasting more than 4 weeks are considered chronic care. Chronic care fees will apply if ongoing care is requested.

  • Repeat Acute Care clients are required to have fast access to a Home Remedy Kit for optimal care.

  • Order a home remedy kit here!

All Acute Care Communication is By Email

  • You will be asked to report by email on a daily basis or as instructed during acute care.

  • This will help the Homeopath to determine a remedy's effectiveness and/or prescribe a new remedy, potency, dosing changes until the acute is over.

Homeopathic Remedies Are Not Included in Acute Care Fees

  • 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 either at your local pharmacy or health food store or on-line as advised by the homeopath.

  • You may order a remedy kit here: 200C Remedy Acute Kit for $149 plus $16.50 shipping and handling.

All fields are required to submit this Form.
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ACUTE INQUIRY FORM

First and Last Name

First and last name of person submitting form

Email

Check for accuracy!

Email of person submitting this form.

Name of Person for Care
Age of Person for Care
Street Address
City
State
Zip Code
Phone(s)

Please provide your home, work, and/or cell phones.

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.

Select one.


If NO, write N/A.
Please describe this acute in detail below, with numbers as follows - answer ALL questions asked:
  1. When did it start
  2. Describe what the acute is in detail.
  3. List all the symptoms for this acute, in order of severity, with the most important one first.
  4. Explain what makes the symptoms feel BETTER (hot, cold, open air, rubbing, etc.)
  5. Explain what makes the symptoms WORSE. (hot, cold, touch, etc.)
  6. Are there any unusual symptoms?
  7. Did anything happen environmentally just before the acute began? (Allergic reaction, exposure to weather, grasses, insects, toxins, etc.)
  8. Did anything happen emotionally just before the acute began?
  9. Treatments used to date?
  10. Anything else important for us to know?

Give us the details for this acute. 

Were you  REFERRED to us? If you are a REFERRAL, please give the name of the person who referred you.

If none, write N/A.

This Acute Inquiry Form is tested regularly and is always working.
If it is not working for you, you have missed filling out a field.

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.

If you have trouble submitting or seeing the above image, refresh your browser and retry.  Be sure to copy the image above exactly.  After 2 attempts, if you still have technical difficulty submitting this Form, please email us the contents requested in this form to: tech@HomeopathyForWomen.org

Please submit only once.

Thank you!

 

This Acute Inquiry Form is copyrighted 2008 - 2016 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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