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Mental/Emotional Inquiry

(Use this questionnaire as a foundation for writing a comprehensive, detailed, thorough, honest and candid life history of your inner nature. Please answer every question! Describe exactly what you feel most deeply, what sensations you have and how they affect your life. Please type or clearly and carefully write your answers in a separate document. It may be as long as you need).


1. Please describe your personality and emotional nature in great detail. Describe all the positives and negatives. Please be honest and candid. This is very important!

2. What is your main, most troublesome, mental and/or emotional problem or limitation? Everyone, including you, has such limitations, i.e., character flaws and quirks, to varying degrees. Please be very honest, humble and forthcoming and do not hide anything. The more truthful and revealing that you are, the more accurate and therapeutically effective will be the selection of your constitutional homeopathic remedy. Describe exactly how the emotional problem or limitation feels to you. What sensations exactly do you feel in your body due to this problem or limitation? What exactly relieves or changes these sensations in your body?

3. How exactly does your main mental and/or emotional problem or limitation influence your life? Give examples.

4. Describe clearly how much, to what degree, to what intensity and to what depth your main mental and/or emotional problem or limitation has affected and continues to affect your life experiences? Give examples.

5. What aspects of yourself and your moods are not pleasant to you? How do you perceive that your moods affect other people? Please give examples.

6. Please describe in detail your daily moods. Describe exactly what makes it change?

7. To what things are you most sensitive, emotionally and mentally? What have others said that you seem to be sensitive to in life? What are your feelings? Please give clear examples.

8. Please tell about your dreams and give specific details. Describe your feelings in the dreams. Tell about at least one dream from your entire life that had an impact on you.

9. Describe any and all dreams and/or daydreams that you would never ever want to have. Use your imagination.

10. What are your strongest worries, anxieties and/or fears? Everyone has these feelings, including you, so please be honest and reveal them. How do they affect your life? What physical symptoms do you have when anxious and fearful? What happens to you when you are startled or scared? Tell about any fears that someone would never ever want to have. Use your imagination.

11. Any panic attacks? Please describe in detail how you feel in your body during a panic attack.

12. How do you feel and behave before meetings, appointments, exams and/or social events?

13. In what situations do you feel impatient and/or frustrated? How do you behave with these feelings?

14. In what situations have you felt and do you feel suspicious, jealous and/or envious? Please describe.

15. In what ways are you affected by and what do you do spontaneously in reaction to criticisms?

16. What do you feel about socializing in public? Timid, introverted, extroverted, wallflower, life of party, etc.? Please describe.

17. What do you feel about making and maintaining friendships? How do friends affect you? Please describe.

18. In what situations have you been and do you feel aggressive? How aggressive do you tend to get, verbally and/or physically? Please give examples.

19. In what situations have you been and do you tend to be depressed, sad, gloomy, brooding and despairing? Please describe in detail. What is the affect of crying upon you? Have you ever thought of suicide? In what ways did you imagine putting an end to your life? Have you ever made any suicide attempts, and, if so, please describe? What happened exactly?

20. What do you feel inside you when you are alone? How do you behave?

21. What is your sensation inside when you suppress your anger? Sadness? Fear? Your needs?

22. What are your passions in life? What makes you most happy? Please give life examples.

23. What are your hobbies, interests and what do you do for recreation? Describe what attracts you to that activity and how it makes you feel inside, exactly what sensations it gives you. What hobbies, interests and recreational activities do you dislike or avoid, and why exactly?

24. To what degree are you sympathetic? About what are you sympathetic? Give examples.

25. What do you feel about events in the world, on TV, in other media? How do they affect you?

26. In what situations do you lose your temper? What physical symptoms do you have when you get angry? I n what situations do you feel revengeful? How long do you hold a grudge?

27. In what life situations have you been mocking, sarcastic and sharp-tongued? In what situations have you been cruel? Please describe and give examples. How do others see you in this regard?

28. What do you feel about animals? What part do they play in your life? What is your most favorite animal and why? What is your most disliked animal and why?

29. What do you feel about plants, flowers and greenery? What part do they play in your life? What is your most favorite plant and why? What is your most disliked plant and why?

30. What do you feel about music, dancing and art? What parts do they play in your life? What special talents do you have? Are you using them, and if not, why not? What do you feel about your artistic abilities and expression?

31. What do you feel about colors? What part do they play in your life? What is your most favorite color and why? What is your most disliked color and why?

32. What do you feel about being in Nature? How does it affect your life?

33. In what ways are you affected emotionally by weather? Rainy, cloudy days? Thunderstorms? Wind?

34. Describe your sense of humor. In what ways are you affected by teasing and practical jokes?

35. How and what do you feel about being around people? In what situations and in what ways are you either quiet or talkative? In what situations are you shy, reserved, awkward, introverted, extroverted, impetuous, lacking or full of self-confidence, cowardly or courageous? Please give examples of each of these characteristics from your life experience.

36. In what situations are you impulsive? Describe exactly what sort of impulses you have, both good and bad, especially any impulses that trouble you, and/or others, in some way.

37. In what situations do you exaggerate the truth, boast or lie? Please give examples.

38. Describe your self-image and self-esteem. How has it changed over the course of your life?

39. What is your pace in life? Are you slow paced or hurried? Please give examples.

40. Describe your attitude and orientation toward sexuality. What role does sex play in your life?

41. What is your reaction to consolation, sympathy and compassion?

42. What is your reaction to contradiction or conflict? What do you feel and do when in conflicts?

43. In what situations are you a caretaker and/or peacemaker? Please describe in detail.

44. In what situations are you a follower or a leader? With what role are you most uncomfortable?

45. In what ways are you affected by untidiness, dirt and disorder? What do you do?

46. In what ways are you organized or disorganized? Are you a Procrastinator? Please give examples.

47. Please describe your daydreams and fantasies in great detail. What sort of daydreams and fantasies would someone never ever want to have? Feel free to use your imagination.

48. What was the most painful, disturbing experience in your life and describe its effects on you?

49. What were the most powerful, life transforming experiences you have had and what were their effects on you emotionally, mentally, physically and spiritually?

50. What is it that you dislike or hate the most? What sort of things do you most want to avoid? Give examples.

51. What is your short and long term memory like? Please describe any problems specifically.

52. Are you forgetful? If so, for what sort of things are you forgetful specifically?

53. How are your concentration, focus and attention? Please describe any problems. What sort of mistakes do you tend to make? What tend to be your weak points? What mistakes do you make when you speak, read or write? When in public versus private?

54. What have you regretted in your life? What would you like to change in your life?

55. What are your ambitions, goals, aims and hopes in life and to what extent have you been able to fulfill them? Tell what you feel about it? How do you envision your future?

56. Please describe any nervous habits that you have, e.g., nail-biting, etc.? What do they make you feel?

57. Please describe any unusual, peculiar or disturbing thoughts and/or ideas that you have and how they affect you? What thoughts and/or ideas would someone never ever want to have? Use your imagination.

58. Please give a clear and detailed picture of your life at home and at work. What is your relationship with every member of your family, your friends and your colleagues? 59. What do you feel about your work, your relatives and the members of your family?

60. What are your responsibilities in life? How do they affect you? How do you feel about them?

61. What are you concerned about in your personal life, your family life, your relationships, your career and your financial affairs? Give examples and describe exactly how they affect you. 62. What are your religious beliefs and in what ways do they influence your daily life?

63. Please describe your political philosophy, your beliefs, viewpoints and strongest feelings.

64. Please describe your philosophy of life in general. Give living examples of your philosophy.

65. Please describe in detail any other problems and concerns that you may have, and exactly in what ways they make you feel, your bodily sensations and how they affect your life.



Thank you for your cooperation in completing this questionnaire. The more detailed, honest and candid are your answers, the better chance that your homeopathic physician has of ascertaining the correct, individualized, most deeply acting constitutional homeopathic remedy for your healing.

Contact Alternative MedCare
Phone: (434) 361-1896 and (434) 361-2573
E-Mail: info@alternativemedcare.com

 

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