507 581 1114 vfc@vitalforceconsulting.com
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Case Record

HOMOEOPATHIC MEDICINE IS MAINLY SELECTED ON THE SYMPTOMS YOU GIVE. I would like to know all the details of your sickness and to understand all the features that belong to you as an individual. This includes your reactions to various factors, your past and family history and your mental make up. This information enables me to select the remedy that restores a balance of health.

In order to find out all about you, I will be asking you many questions. Each one of these questions has a definite meaning and significance for me. Even something you may think is not connected with your trouble may be the most important factor in deciding the correct homoeopathic medicine. Remember, whatever you tell me will remain confidential.

I would encourage you to fill out the questionnaire completely and mail it to me a week before your appointment. The completed questionnaire received on time may help reduce the time of consultation. If you cannot, I understand, but please let us know the nature of the difficulty.


  1. About your past illnesses and family illnesses. Please take time to answer this part with the help of your family members.

  2. History of your present illness.

  3. About all the parts of your body.

  4. Deals with the factors that affect your health. Please think carefully about each of the factors mentioned and write what specific effects they have on you. If there is a factor that has no effect, please feel free to leave it blank.

  5. About your mental state and your emotional nature. Please write in this part about your situation in life and about all the things that are bothering you.

  6. About your sleep and dreams.

  7. For children or you as a child.

  8. In this part you are given instructions on how to report each of your complaints. Read the instructions first. Then make a list of your complaints and describe each of them according to the instructions.

Sujata Owens, RSHom(NA), CCH, HMC
Vital Force Consulting, Inc.
101 5th Street East
Northfield MN 55057



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For more information, or to schedule an appointment with Sujata, call 507.645.4329


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