Case-taking template — printable download

A two-page printable PDF for first-consultation intake in the classical, Boenninghausenian, and post-classical traditions. The form structures the case around the Hahnemannian observation hierarchy — mind and disposition, then generals, then particulars — and reserves space for the modalities and concomitants that govern rubric weighting in Kent's repertorial method. Free to reproduce, modify, and share inside a single practice.

The companion repertorization sheet PDF follows the completed intake: once modalities and concomitants are recorded here, the sheet provides the column grid for scoring rubrics against candidate remedies.

What the template captures

Eight blocks divide the form. Patient identifiers and signed consent occupy the masthead, followed by the chief complaint stated in the patient's own words. Mental and emotional symptoms — fears, dreams, susceptibilities, affections — fill the upper half of page one, in keeping with the priority Hahnemann assigned in §211 of the Organon to symptoms of the disposition. Generals (sleep, appetite, thirst, perspiration, menses, sexual sphere) and modalities (aggravation and amelioration by time, temperature, posture, weather) occupy page two, with concomitants and a follow-up margin reserved for the second consultation.

Paper template vs. structured digital intake

Neither side dominates. A paper template removes the practitioner-screen barrier that some patients report as off-putting during a first consultation and leaves a tangible artefact for the file; a structured digital intake removes the re-keying step and exposes the case to cross-case search across the archive.

Working with the PDF in a first consultation

Print one copy per patient, fasten it to a clipboard, and keep a second blank copy on the desk for running notes. The patient-words column on the left of each page is filled verbatim during the consultation; the rubric-translation column on the right is completed afterwards, by hand or by transcription into a repertory. Hahnemann's instruction to record symptoms in the patient's own language before any interpretation is the discipline the form is built around — preserve it strictly for the first three years of practice, and the habit will hold for the rest of a career.

A second consultation re-fills the follow-up margin rather than a fresh form, so the chronological arc of the case stays on a single sheet for the duration of the prescription. Practices that retain the paper case as the legal record can scan the sheet into the digital file at the end of each session.

When to graduate to a structured digital case file

Printable templates scale poorly past a few dozen active patients. At that volume the cross-case retrieval problem — which previous patient presented with this same modality cluster? — becomes intractable on paper. For practices not yet on a paid system, the free online repertory closes part of the gap: rubrics can be searched and scored by symptom without account creation, though results are not persisted across sessions. Beyond that volume, a full case-management surface with indexed search, live transcription, and AI-assisted summarisation — such as Similia — becomes the natural successor to the clipboard.

References

Hahnemann, S. (1842, 6th edition) Organon of the Medical Art, §83–§104 (case-taking) and §211 (symptoms of the disposition), Köthen.

Kent, J. T. (1900) Lectures on Homœopathic Philosophy, lectures XXXII–XXXV on case-taking, Lancaster, PA.

Boenninghausen, C. von (1846) Therapeutic Pocket-Book, Münster — for the modality-and-concomitant framework on which page two of the template is built.