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Acute Care Request

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Homeopathy for Women

 Acute Care Services

Acute Care is provided in the USA and Canada Only. 
An acute issue is something that is a sudden onset and lasts LESS than 30 days.
Conditions lasting 30 days are considered chronic care -  you must request chronic care instead.

Homeopathy is NOT Urgent Care! For urgent or life-threatening issues,
call your doctor, medical practitioner or 911 now.

PLEASE READ THIS BEFORE SUBMITTING THE FORM BELOW.

We DO NOT accept new acute requests if the Client has already started any acute prescription drugs, including steroids, inhalers, antibiotics and/or are currently being hospitalized.
Medical insurance does not cover our homeopathic services.

 Acute Care Request are only accepted Monday - Thursday
from 9 am - 4 pm (PST).
We will not reply to any requests submitted after business hours,
on all Fridays, weekends or legal holidays.

Returning Acute Care Clients must have access to a 200C remedy kit for care.

Acute Care Fees - Health Conditions must be 30 days or LESS for acute care.

  • Acute Care: $150 per person, per acute for 7 days of consecutive care is paid in advance via Paypal.

  • Care is available for women, men and children by email for short term, non-life threatening illnesses like: fevers, chills, colds, flu, coughs, vomiting, diarrhea, earaches, teething, back pain, sports injuries, etc.

  • Acute care includes the initial acute intake, cases analysis, acute remedy prescription(s) and any required remedy or potency changes during the acute for up to 7 consecutive days.

Extensions to Acute Care

  • Extended Acute Care is available at an additional $100 per week.

  • Acute care may be renewed if needed up to a maximum of 3 additional weeks at the same rate (up to 4 weeks maximum).

  • Acute illnesses lasting more than 4 weeks are considered "chronic care". 

  • Chronic care fees will apply if ongoing care is requested.

  • Repeat Acute Care clients are required to have fast access to a Home Remedy Kit for optimal care.

All Acute Care Communication is By Email

  • You will be asked to report by email on a daily basis or as instructed during acute care.

  • This will help the Homeopath to determine a remedy's effectiveness and/or prescribe a new remedy, potency, dosing changes until the acute is over.

  • 90% of acutes we handle are stable in 7 days or less, depending on the issues, with full compliance by the client.

Homeopathic Remedies Are Not Included in Acute Care Fees

  • Your Acute Care Fee does not include the cost of any remedy(ies) that are prescribed.

  • It is the client's responsibility to obtain the remedies prescribed either at your local pharmacy or health food store or on-line as advised by the homeopath.

  • You may order a remedy kit here: 200C Remedy Acute Kit for $159 plus $17 shipping.

All fields are required to submit this Form.
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ACUTE INQUIRY FORM

First and Last Name

First and last name of person submitting form

Email

Check for accuracy!

Email of person submitting this form.

Name of Person for Care
Age of Person for Care
Street Address
City
State
Zip Code
Country
Phone(s)

Please provide your home, work, and/or cell phones.

Best Time(s) To Call Please provide best times to call, if we need to reach you by phone.
Have you ever used homeopathy before?

If YES, please give the NAME of your most recent Homeopath.

Select one.


If NO, write N/A.
MAIN ISSUE
Pick the ONE for which you are seeking care

Select only one (1) from below.

Please describe this acute in detail below, with numbers as follows - answer ALL questions asked:

Limit Your Answers To the Space Provided, be specific. Anything not fitting in the space will be cut off in the form.

Copy the text for the questions below and answer them after each, in this order.

  1. Describe acute in detail.
  2. When did this acute start?
  3. List 5 main symptoms for this acute, in order of severity or concern, ranked with the most important one first.
  4. What makes the acute symptoms feel BETTER. (no movement, cold, heat, motion, etc.)
  5. What makes the acute symptoms feel WORSE. (exertion, standing, lying still, eating, talking, etc.)
  6. Describe any unusual symptoms.
  7. Did anything happen environmentally just before the acute began? (Travel, exposure to other sick person, allergic reaction, exposure to weather, insect bite, toxins, injury etc.)
  8. Describe anything that happened emotionally a few days before the acute began.
  9. List any medical drugs, treatments homeopathy or supplements used so far for this acute.
     
  10. Provide anything else important for us to know!

 

Give us the details for this acute. 

Were you  REFERRED to us? If you are a REFERRAL, please give the name of the person who referred you.

If none, write N/A.
How did you find out about Homeopathy for Women?

Please choose only one.

Your information is always kept private and confidential.
By submitting this Form, you give Homeopathy for Women
and any of its Associated Homeopaths permission to contact you by phone, Skype and/or email. 
You will be contacted as soon as possible if this was submitted during our business hours.

A confirmation screen will appear after your successful submission.
You will immediately receive a detailed confirmation email sent to the address used in this form.
If you do not receive this email, you did not successfully submit this form. Review and try again.

CHECK YOUR SPAM FOLDER!
Your confirmation email will be from
FormMail@HomeopathyForWomen.org

We reply to all inquires for waiting list placement or to schedule within 3 days during business days.
You must also add to your email contact:  kari (at) HomeopathyForWomen (dot) org
If you do not hear back in 2 hours during our business hours, recheck your spam folder.

After 3 attempts, if you still have technical difficulty submitting this Form, email all the information requested above to:
kari (at) HomeopathyForWomen (dot) org

Please submit only once.

Thank you!

 

This Acute Inquiry Form is copyrighted 2008 - 2018 by Homeopathy For Women. 
All rights reserved.  No part of this Form or the on-line reporting system may be copied, reproduced digitally or in print without our written permission.




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