Back to home page
Please fill in the form below and submit, or email me directly
the.homoeopath@similars.co.uk
Name
Age
Male
Female
Address
City
County/State
Zip/Post code
Country
Phone
email
Current condition
?
Please type as much information about the symptoms you are experiencing - including what makes them better or worse
Past History
?
- please include details of all past illnesses, including childhood illnesses, operations and accidents.
Mental/Emotional state
?
- how you have changed since the onset of your particular problem
Character
?
- your strengths and weaknesses, likes and dislikes, fears, desires...