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  • Two Legs and Four Holistic Health - Child Questionnaire (0-10 years)

  • In order to make an accurate prescription, I depend on your co-operation. Homeopathic treatment is mainly based on the symptoms you provide me. If I am to make a successful prescription, I need to know all the details of your child's problems. I must also understand them as an individual, including their reactions to stress, their past, their family history, their nature and their mental make up.

    Young children are very imaginative and I want to understand their world through their words. This inner fantasy world is a gateway for a homeopath to enter.

    The mother's state during the pregnancy has enormous significance to the constitution of the child, so please do your best to recall details of that time. How the mother felt, perceived or sensed her world was felt by the child. The father's state at the time of conception is also significant.

    The information you provide enables me to restore their health. In order to achieve this, I shall be asking both you (the parent or guardian) and the child (where possible) many questions. Each one has great significance to me, even those you may consider irrelevant to their health issue. This is why you need to be frank and free with all the relevant information.

    Where possible, please use the child's words. Where possible, please fill the questionnaire out with the child, so they have their say.

    Please read each question carefully. Don't keep anything back. If necessary, ask someone close to you for more information. Everything you tell me is in complete confidence. This is a lengthy questionnaire, so be prepared to take time to fill it out.

    Rather than use he/she, I use the term 'them', 'they'.

    You can save the document to complete later. Make sure you click on 'Submit' at the end.

    You can fill out as much or as little as you desire. However, the more info I have the better able I can help. Health is complicated and many factors contribute to ill health. Homeopathy examine every possibility.

    PLEASE NOTE - THIS FORM DOES NOT AUTOSAVE. YOU HAVE TO CLICK ON THE SAVE BUTTON AT THE END IF YOU NEED TO COME BACK LATER TO FINISH IT

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  • Section 1 Your Child's Health Concerns

  • Section 2 Conception, Pregnancy, Delivery

    Please provide details
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  • Section 3 Growth, Development, Milestones

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  • Section 4 Your Child's History and Family History

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  • Section 5 Environment

    Check all the factors that apply to your child's current life

  • Section 6 Drug, Vaccine History

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  • Section 7 Sleep, Dreams

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  • Section 8 Food, Thirst, Digestion

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  • Section 9 Body

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  • Section 10 Mind, Emotions, Activities, Hobbies

  • Section 11 Check List

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  • Thank you!

    CONGRATULATIONS in completing this marathon questionnaire! This is a significant step in your child's journey to wellness.

  • Re-scheduling, Privacy

  • Re-scheduling or Cancellations

    Homeopathic consultations take time. My appointments are lengthy to discover the core reason for your ill health. So cancellations or failure to make an appointment makes a big impact on my day. Inevitably there are times where you need to re-schedule your appointment. Wherever it is possible, I do appreciate you giving me as much notice as possible, at least 24 hours is preferred. Often, people ring me early in the day for an appointment and it is frustrating for us both when there is apparently no free slot, which ultimately becomes available.Those who fail to attend to a prearranged appointment or don’t give me 24 hour advance notice may be charged for the full consultation. I appreciate your consideration.
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