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First and Last Name
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We accept clients living in the USA - or with a shipping address in the USA.


Select the Main Type Of Homeopathic Care

Select the main one from these options.

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What is the ONE (1) main health issue for which you are seeking homeopathic care.

How long has the ONE (1) main health issue been a health condition?

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What are the CURRENT HEALTH ISSUES occurring now at the same time?

Select all that currently apply.

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Name each current or suspected diagnosis, in chronological order with the year it started after each.  

List any active medial diagnosis within the last 5 years.

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Number of total current diagnoses

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or suspected current diagnosis(es).

Has the person or member(s) of the immediate household received any Covid pandemic vaccine(s)?

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Is the person for care a Christian?

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COMMENTS: Please provided us with more general details on the nature of your inquiry. Please add your comments to submit this form. You must submit something below to submit this form.

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Have you ever used homeopathy before or worked with a professional Homeopath before?

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