Free Assessment - HomeoAI | AI-Powered Homeopathic Consultation

Personal Information

Let's start with some basic information about you

Your information is completely secure and confidential. We use encryption to protect your data.

First Name * Please enter your first name

Last Name * Please enter your last name

Email Address * Please enter a valid email address

Phone Number * Please enter your phone number

Age * Please enter your age

Gender * Please select your gender

Describe Your Symptoms

Tell us what you're experiencing. Be as specific as possible.

Which part of your body is affected? *

Head

Eyes

Nose

Throat

Chest

Stomach

Back

Joints

Please select at least one affected area

Describe your symptoms in detail * Please describe your symptoms

How long have you had these symptoms? *

Less than a day

1-3 days

4-7 days

1-2 weeks

More than 2 weeks

Please select symptom duration

Health & Lifestyle Details

Help us understand your overall health and daily habits

Rate your pain level (if applicable)

0

No Pain

1-3

Mild

4-6

Moderate

7-9

Severe

10

Worst

What makes your symptoms worse?

Heat / Hot weather

Cold / Cold weather

Movement / Activity

Rest / Lying down

Eating / Food

Stress / Anxiety

What makes your symptoms better?

Heat / Warmth

Cold / Cool air

Pressure / Massage

Rest / Sleep

Movement / Walking

Eating / Drinking

Medical History

Your medical background helps us provide better recommendations

Are you currently taking any medications?

Do you have any known allergies?

Do you have any chronic health conditions?

Have you tried homeopathy before?

Never

Once or Twice

Regular User

Any additional information you'd like to share?

Free AI-Powered Assessment

Personal Information

Describe Your Symptoms

Health & Lifestyle Details

Medical History

Assessment Submitted Successfully!