Adult Homeopathy Questionnaire

Deborah Olenev, C.C.H.
59 Paul Avenue
Mountain View CA 94041
(650) 569-6219 voice mail
(650) 625-0692 home
(650) 386-5415 fax

Adult Homeopathy Questionnaire


What is your name?

What is your date of birth?

What is your address?


What are your phone numbers?


Please answer as many of the following questions as you can in preparation for your initial consultation.  If you find this difficult to do, don’t worry about it, we will explore further during your session, and I will help you tell me the story of your illness.


Please tell me about the genetic background of the family:  diseases of parents, grandparents and siblings.




Physical Sphere


1)     What are your physical complaints?  When did each of them begin, and what   makes them feel better or worse?

2)     What foods do you have a craving for?  Are there any foods that you have an aversion to?  Are there any foods that aggravate you in any way?

3)     Please tell me what you eat on an average day for breakfast, lunch, dinner and snacks?

4)     How thirsty are you?  What do you like to drink?  Do you use ice in your drinks?

5)     Please tell me what your physical and emotional responses are to the following weather conditions: sunny weather, rainy weather, thunder and lighting storms?

6)     Would you say that you are more sensitive to the heat or cold?  Are any parts of your body colder or hotter than other parts?

7)     Is there a natural environment that you prefer or feel better at?  For example, ocean, mountains, desert.

8 )    Do you have any problems with sleep, such as frequent waking, or difficulty falling asleep?  Do you like to sleep well covered, or do you uncover your arms or feet?  What is your favorite sleep position?

9)     What is the time of the day when you feel most energetic?  What time of the day do you feel most tired?  Please be specific as to times, and let me know from when to when?  What time are your symptoms most troublesome?

10)    How often do you catch colds?  What symptoms do you typically have during a cold?

11)    For women: How are your periods?  Are you experiencing any PMS symptoms?  If you are in menopause or perimenopause, are you experiencing any problems?

For men:   Do you have any sexual problems, please explain.

12)    What kind of exercise do you do?  Do you feel better or worse from exercising?

13)    Do you have any problems with your skin?  Please describe.

14)    Do you have a tendency to perspire, day or night, and on which part of your body?

15)    Have you experienced any accidents, which have caused health problems?

16)    Are your fingernails and toenails healthy?  Please indicate if there is any thickening, ridging or discoloration of the nails.

17)    What medications are you taking, and what are they for?

18)       Have you had homeopathic treatment in the past? Please let me know the remedies you have taken, the potencies, the dates you took them and about your response to the different remedies. Also, please me know about other treatments you have had for your health conditions.


Personal History


Please tell me where you were born, the number of kids in your family, about your relationship with your parents and siblings, your education, work history, marriage, etc.   Please bring me up to today.  I would appreciate you sharing any information that think would help me formulate an understanding of you and your personal circumstances.  Everything you say to me will be kept confidential. This section is very important to my understanding of your case, so please do not forget to complete it.


Emotional Sphere


1)     What are the activities you enjoy doing?

2)     Are you a moody person?  What are the moods you tend to go into?  Do you get depressed or cry easily?

3)     Do you tend to get angry or impatient?  Do you show your anger openly or try to hide it?  How do you express your anger?

4)     What are your fears?  Are there any situations where you feel anxious?  Do you fear any animals?

5)     Are you a worrier?  What do you worry about?

6)     Do you have a tendency to dwell on the past?

7)     When you are feeling upset do you want consolation, or to be left alone?

8 )     Are you a sympathetic person?

9)     Are you perfectionistic in any area of your life?  Which areas?

10)    Do you tend to be neat or messy at home and at work?

11)    Are there any types of people that you do not get along with?

12)    Do you like to read, and if so, which types of reading matter?

13)    Do you experience nightmares, or recurring dream themes?  If you would like to, you can tell me a dream that you feel is significant.

14)    When you have an appointment, do you tend to arrive on time, or do you come late?  How late do you run?

15)    Would you say you are a hurried person, or slow?

16)    Have you had any addictions in your life?  Do you have any bad habits, such as nail biting?

17)    How do you feel about animals?  Are you a big animal lover, or are you neutral or indifferent to them?

18)    Do you have a jealous streak?

Mental Sphere


1)    Do you have any problems with your memory?  What kinds of things do you have a problem remembering?

2)    How is your concentration?  Do you get distracted easily, or have difficulty focusing your attention on tasks?

3)    Are you religious?  Do you have a prayer or meditation practice?

4)    I mentor homeopathic students and visiting homeopaths from time to time.  Would you be willing to allow another homeopath to sit in on the case taking process?

Thank you for completing this questionnaire.


Skip to comment form

  1. It’s nearly impossible to find knowledgeable people about this subject, but you seem like you know what you’re talking about!

  2. Dear Quentin,
    Thank you. I am happy that you like my articles. Yes, it is fine for you to grab the feed.

    I wish you all the best.

    Warm regards,

    Deborah Olenev CCH RSHom (NA)

    • Quentin on April 7, 2019 at 11:51 am

    Simply want to say your article is as amazing. The clearness in your post is
    just great and i can assume you are an expert on this subject.
    Well with your permission let me to grab your feed to keep updated with forthcoming post.
    Thanks a million and please continue the enjoyable work.

  3. Dear Ramachandrababu,
    Thank you for introducing yourself. I was introduced to homeopath from an excellent introductory book I read 35 years ago, but unfortunately I do not remember the title.

    Please visit Homeopathic Educational Services. They have an excellent catalog from which you can select books on homeopathy. Their website is:

    You can also talk to Dana Ullman, the owner of that company, and he can make recommendations to you.

    Amy Lansky’s book, “Impossible Cures” explains homeopathy very well.

    I wish you all the best.

    In love and service,

    Deborah Olenev CCH RSHom (NA)

    • RAMACHANDRABABU VASILI on July 25, 2018 at 10:48 pm

    I am V Ramachandrababu, aged 41 years living in India. Working as Asst. Professor of English in Sree vidyanikethan Engineering College, Tirupati, AndhraPradesh, India.

    Browsed your website. Its authentic

    Want to know which is the best book to start for homeopathy.

  4. Dear Vin,
    Thank you for your blog comment. The approach of the homeopath you are working with is not a classical homeopathic approach, because he or she is using three remedies in high potencies rather than one remedy at a time and repeating way way way too frequently. Please read the article on this website entitled How To Take Homeopathic Remedies.

    My suggestion is to discontinue all of the remedies you are taking. If stomach symptoms are not usual for you, you can be having a side effect from any of these remedies and we do not know which. So please stop what you are doing, and take a break from any remedies for two months, then work with a homeopath who does classical homeopathy, and can take your case at that point.

    I hope you feel better soon.

    In love and service,

    Deborah Olenev CCH RSHom (NA)

    • vin on July 6, 2018 at 8:23 am

    I just started taking 5 drops of the following medicines twice to thrice a day, as prescribed by a Homepatthic Doctor, for back pain and plantar faciitis:

    1. Coloncynthis 200ch
    2. Rhus Toxicodendron 200ch
    3. Calcarea Fluorica 200ch

    My stomach is upset and I have to use the bathroom three times or more a day. I read about these medicines online, not sure if Rhus might be causing this? Please advise.

    thank you,


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