Child Bach Remedy Questionnaire


Natural Treasure Holistic medicine
Mohamed El Siddig , NSHS, DMHS ( HD)
Homeopathic Doctor & Healer
Hypnopath/ Psychopath
Hamilton ,ON
Barton East
2892441179

Homeopathic consultation is facilitated when there is a complete picture of the individual’s mental, emotional and physical states of health.  This includes symptoms that affect both physical sensations (what does it feel like), and function (how it impacts you) and what ameliorates or aggravates each symptom.

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Children questionnaire (under 10 years old):

Does s/he whine and take offense frequently?
 1 2 3 4 5 6 7 8 9

Does the child demand constant attention?
 1 2 3 4 5 6 7 8 9

Is the child high-strung or demanding? Does s/he want it all—now?
 1 2 3 4 5 6 7 8 9

Does the child try to hide his or her distress and put on a face of “everything’s OK”?
 1 2 3 4 5 6 7 8 9

Is the child Fearful?
 1 2 3 4 5 6 7 8 9

Is the child Very quiet?
 1 2 3 4 5 6 7 8 9

Is the child Withdrawn?
 1 2 3 4 5 6 7 8 9

Is the child bashful?
 1 2 3 4 5 6 7 8 9

Is s/he afraid of disappointing, or does s/he feel a need to satisfy parents or others?
 1 2 3 4 5 6 7 8 9

Does the child feel guilty?
 1 2 3 4 5 6 7 8 9

Does the child have trouble learning or grasping material?
 1 2 3 4 5 6 7 8 9

Is the child depressed, sad, or ill?
 1 2 3 4 5 6 7 8 9

Is the child far from home or family, and is homesick?
 1 2 3 4 5 6 7 8 9

Does the child give up easily, or feel that it’s not worth trying?
 1 2 3 4 5 6 7 8 9

Does the child suffer panic or extreme fear?
 1 2 3 4 5 6 7 8 9

Does the child sleep an inordinate amount, yet complain of fatigue?
 1 2 3 4 5 6 7 8 9

Was s/he born prematurely?
 1 2 3 4 5 6 7 8 9

Is the child small or weak?
 1 2 3 4 5 6 7 8 9

Does the child lack confidence?
 1 2 3 4 5 6 7 8 9

Is the child a loner?
 1 2 3 4 5 6 7 8 9

Does s/he find it difficult to deal with failure?
 1 2 3 4 5 6 7 8 9

Is the child restless?
 1 2 3 4 5 6 7 8 9

Does the child lay blame or always say, “It’s not fair”?
 1 2 3 4 5 6 7 8 9

Does the child experience mood swings?
 1 2 3 4 5 6 7 8 9

Homeopathy is considered to be an alternative/preventative system of health care and is not intended to be a substitute for allopathic or traditional medicine.

The therapy and information offered should not be construed by you, the client, or any family, friends or caregivers to be a medical diagnosis of any disease or injury.

You should consult with your physician for any serious medical condition and further, you should get at least two medical opinions for such condition.

While Mohamed El Siddig ,DHMS , DMLS , ( HD) ,CMA member has had extensive training in the science and art of Homeopathy .

I HAVE READ THE ABOVE AND AGREE TO ALL TERMS:

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