“The only way a disease can be cured permanently is by administering a medicine which would produce a similar state of suffering in a healthy individual.”



The goal of the sequential part of your treatment is to address the blockages caused by physical and emotional shocks, in order to liberate your life force and assist it in it's journey to a healthy balanced state. We remove the blockages in reverse order of their appearance, so that the 1st shock we remove is the most recent. We go all the way back and deal with birth and gestation as well. We then address the inherited pre-dispositions which are commonly divided into five categories. Individually and collectively, these are the source of many chronic ailments, whether physical or emotional in nature..

A time line is necessary to map out the course of your treatment. Please make a list of any physical and/or emotional shocks you can remember. Begin with today and go back all the way to birth and gestation. Please see the reverse side of this page for a list of physical and emotional shocks to guide you in establishing a chronological time-line. If in doubt, list the event and we can discuss it's relevancy. You would then take this information and add in the emotional shocks for a full timeline.

Typically, we address a new shock/trauma every four weeks or so. Anywhere from 10 to 14 days after taking the remedies to deal with this event, you will experience a healing cycle. This may involve a worsening of your overall condition and/or the return of old symptoms. The healing cycle may last up to 4 days, after which you will experience an improved state of health.

The information you supply and your participation are an essential part of your healing. Please feel free to discuss any questions or concerns you may have.

Time line Information


Name:___________________________________________   Phone Number:________________________


___________________________________  E-Mail _______________________________________
Date of birth:______________  Blood Type:____

Present Complaints:

Symptoms (please note current symptoms and any chronic problems)

Patient Medical History


Emotional Traumas  
Family Medical History (please note any serious illness)


This list is by no means exhaustive. If there is an event that you feel has had an impact on you, please do list it.

Physical shocks:

Pre-birth: drugs, cigarettes, alcohol, accidents, exhaustion, severe illness, ultrasounds

Birth: difficult or prolonged labor, induction, forceps/vacuum extraction, anesthetic/epidural, C-section, medications

Post-natal: circumcision, interventions, prolonged separation from the mother

Vaccinations: childhood, travel, flu, hepatitis, meningitis

Accidents: blows to the head, back injury, falls, whiplash, car/bike accidents, broken bones

Surgery: includes wisdom teeth removed, tonsillectomy, tubal ligation, vasectomy...

Dental work: root canals, X-rays

Drugs: any and all prescription drugs (antibiotics, antidepressants, birth control, hormone replacement therapy, painkillers, cortisone), "puffers" for asthma, recreational drugs,

Viral infections and childhood diseases: chicken pox, mono, Epstein Barr, Lyme, meningitis

Miscellaneous: Barium treatments for diagnostic purposes, X-rays, MRIs, electric shock therapy, lightening, CAT scans,

Emotional shocks:

It is particularly important to list those events where the emotions were not fully expressed.

Loss: loss of childhood, moving, loss of pets, relationships breaking up, loss of trust, betrayal, embarrassment, job loss, divorce, death

Fear: witnessing an accident or violence, this emotion is often suppressed or goes unnoticed

Anger: indignation/humiliation, resentment, guilt, loss of control over life's events, abuse

Jealousy/Envy: sibling rivalry, past up for promotion...

Example of timeline:

Dec ’99 :Root canal
Aug 98 : Death of close friend Jan
May 98 : Cortisone shots for injured knee
Oct 95 : Laser eye surgery
91 : Start B.C. pill
Sept 89 : Tonsillectomy

Click here to Download PDF of Patient Form