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Intake Form For All Homeopathic Cases at FreeHomeoce.com

This is a required intake form for all Homeopathic consultations. Academic to Advanced Homeopathy created by Mr Vimal Patel Rs Hom N A

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Name of Client being treated

Address to ship the remedies for free

Phone number

Vedic Astrological Homeopathic Remedies created by Mr. Vimal Patel Rs Hom NA Please Enter Date of Birth , Time of Birth and Place of Birth. To skip type N/A.

Main Health issue for seeking Homeopathic treatment

Optional : Write much details of all Health issues. Prescription Medications. Take a Head to Toe review of yourself and list all Health problems/issues *FEELINGS*. What is important Homeopathically is periodic issues, recurring issues, any issues that has a feeling associated with it, any symptoms, Cold weather or Hot weather effect on you and your symptoms. recurring pattern of Dreams****

Check here if you want Academic Case taking . Will be shared with Alternate health care practitioners, students for knowledge and learning. Your case must be eligible for Academic Case review. All sessions are recorded and transcribed for analysis and remedy selection. Automatic switch to private consults if determined by homeopath.

Check here if you want Private Consult. Premium Clients. Chronic health issues requiring multiple visits are all Private. All sessions are recorded and transcribed but not shared with anyone unless I have to consult another Homeopathic practitioners for Chronic cases that show no improvements after 1 to 3 visits.

Accept Homeopathic treatment disclosures and agreement click submit button below.

Intake Form For All Homeopathic Cases at FreeHomeoce.com

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