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Homeopath's Name *
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Practice Location
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Homeopath's Email Address
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Homeopath's Phone Number
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Homeopath's Degree's: Check all that apply.
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If other, please specify:
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Homeopath's Certifications: Check all that apply.
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If other, please specify:
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Do you have the patient's permission to post the
case?
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Fictitious First Name of Patient (never use
patient's real name or initials - use only the fictitious name
you make up for the patient throughout your description of the
case)
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Patient Gender
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Patient Marital Status
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Brief statement of why the case is worth reading:
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Approximately how long did you continue to get
follow-up information on the patient (state days or months or
years) after their first visit with you?
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How many visits (approximately) did you have with
the patient?
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Description of Patient's Appearance and Notable
Behaviors during Case-Takin
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Patient's presenting (chief) complaint (why did they
come to see you originally?)
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Patient's allopathic diagnoses (complete list)
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Patient's allopathic drugs (prescribed and over the
counter)
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Other forms of complementary and alternative
medicine the patient has used and/or now used at the time of
initial interview - and for what problems? Did those treatments
help?
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Family history of allopathic diagnoses and/or causes
of death in blood relatives
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Notable excerpts of the patient's own words
describing their case (include mentals, generals, specific
physicals).
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Summary of other aspects of the case-taking
interview and observations (including information from
significant others, charts, other health care providers)
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What was your initial analysis of the case in terms
of remedy possibilities (kingdom, family, specific remedy) and
potency (specify strength of vital force and center of gravity
evaluation; other clinical considerations such as concomitant
allopathic drug
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What did the patient report during each follow-up
visit?
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What did you observe about the patient during each
follow-up visit?
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List the aspects of the case that improved, if any.
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List the aspects of the case that worsened, if any.
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List the aspects of the case that did not change, if
any.
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List of Remedies and Potencies Given, by date (if
possible, specify month and year of each dose)
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Share your ideas about the case as it developed -
what may have led to changes in remedy selection or potency? How
do you see the patient's outcome (your assessment as a
homeopath, not necessarily what the patient reported)?
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Final Comments (please add any other information or
comments that you consider essential for readers to know or to
think about in applying this case report information in their
own practices).
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May we have your permission to publish this case on
www.txoptions.com?
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