Therapies Case Record Form

Therapies Case Record Form

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Name
DOB
Address

Welcome to Healing Harmony Homeopathy & More Clinic.

We are glad you are taking the steps towards inner-work! We believe that man is an organic unity, it’s a beautiful union of the body, the mind and the soul and that man needs not only the treatment of the part that is sick. Hence our approach is multi-dimensional and we offer a range of holistic therapies including Yoga, Meditation, Diet, Zen Counselling and other healing techniques along with homeopathic treatment. There is also a lot of material for you to read and understand principles of holistic health and for each of these systems and how they work, please ask at reception and feel free to discuss with the clinic regarding any question(s) you may have. For more information visit www.healingharmony.in and www.karvaanretreat.com In order to find out all about you, we shall be asking you many questions. Each one of these questions has a definite meaning and significance for us. You must be free and frank, give us complete and true information on each point. Please read each question carefully, think and then answer completely. Do not keep anything back. Remember, whatever you tell us will remain absolutely confidential.

CASE RECORD

Your general health has been

PREVIOUS DISEASES & DRUGS USED

FAMILY INFORMATION

PERSONAL INFORMATIONS

Thank you for your patience & co-operation in filling up this case record. This will help us during our work together during the therapy sessions.