Family Name: * First Name: * Email * Phone * Birth Date/Time: Profession Body weaknesses and injuries Diseases / Symptoms / Main Concern File Upload - Please add any clinical reports, blood- and tests reports, x-ray pictures, or similar
Do you take other prescription drugs or remedies? Do you take dietary supplements? Do you have allergies or intolerances? Environmental Influences (Geopathic Stress): Menstruation - please check all that apply Surgeries in your life Difficult diseases in your life Most frequent health issues in your life All therapies during last 12 months & results you got Please list all your symptoms, pain, impairments, major and minor ailments
How do you sense these symptoms, pain: pressure, pulsating, choking, pounding, cutting, etc. Please provide a good description if possible, with visualization and imaging as best as you can.
Where do you feel these symptoms/pain; are these radiating and, if yes where? If worsening occurs which are the factors aggravating the symptoms/pain?
Examples: Movement, lie down, pressure, a temperature higher or lower than usual, storms, weather changes, water contact, specific time of the day, during sleep, seasonal, light or excessive sunshine, when eating, when excreting, when menstruating, nervous, stress, dispute, grief, anxiety, worries, full moon.
Same question regarding when you feel better and your symptoms are softening. Were you already consulting with: (check all that apply) Please list out details Do you think your health issues may be caused by your psycho-mental state of mind? Do you have also some other “minor ailments”, temporary or softly disturbing you? Which are the diseases you had in the past, which manifested in an acute way, and which healing easily? Did you have in your childhood recurrent health conditions? How many and if possible, which vaccines did you get. Was there any reaction thereafter, any special symptoms? Which other diseases, surgeries, special conditions, and therapies did you have and when? Have you noticed any skin changes, eczemas, which kind, and when? Were these treated, which therapies were applied? Do you feel cold or heat more than average? Do you take your shower warm or cold? Do you prefer to drink warm or cold liquids? Which are your preferred drinks and food? Do you sometimes want some specific food or drink but you are having incompatibility or adverse reactions (such as allergies, nausea, vomiting, diarrhea, etc.) when consuming them? Do you prefer saltier foods? Do you try to avoid salt? Do you prefer sugar (sweet) foods? Do you prefer fattier foods? Do you try to avoid fats? Do you see or feel any special reactions or symptoms when excreting stool, urine, period bleeding, sweating?Which body zones do you experience sweat? Please list: (copy) Do you have anxiety, fears, panic when thunderstorms are occurring, claustrophobia, height fear, small rooms, public speaking, or performing? Do you dream often, and do you see repeatedly dreams; which are your dreams, do you remember these? Which are now your major health concerns and targets?