After Hours Acute Care Consultation Form - Austin Clinic of Homeopathy
Please note you don't have to have COVID-19 symptoms to utilize this service, but is being offered to you amidst the rise in needs from all in our community.

Answer the questions below as detailed and specific as you can. I will respond within 24 hours. If you have an immediate need requiring urgent attention, please call me and leave a voicemail. I will respond as soon as I'm able.
First and Last Name *
Email *
Preferred Phone Number *
Describe your chief complaint/s (include exact locations, specific pain sensations) *
When did symptoms begin? Please be specific about date and time. *
What stress are/were you experiencing recently leading up to the onset of symptoms? *
When do you have symptoms? Be sure to clarify ranges of time, if applicable. *
What makes the symptoms feel better or worse? (Ex: drinking hot liquids to soothe a sore throat) *
What is your strongest emotional feeling associated to having these symptoms? *
Please include any additional information not covered in the above questions.
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