Live Case Request form

Interested in affordable homeopathy, & feel up for sharing your homeopathic consultation with a group of student observers? These 1-2-hr appointments are well-suited to cases where there are deep-seated issues and challenges. Please fill out the form below so we can assess whether your case is appropriate for the teaching clinic setting. We will get back to you within three business days. If your case is approved, you will be contacted by our administrator for scheduling. If your case is not approved, we will happily recommend a local practitioner who will be willing to see you in their private practice. For further questions, please email support@baylighthomeopathy.com, or call 207-774-4244.

Name *
Name
Phone *
Phone
Date of Birth *
Date of Birth
In a word or two, please describe the issue(s) for which you are seeking help.
Please describe your complaint in more detail. A paragraph or two should suffice (Ex: how long has this been going on, how has it affected your quality of life, is this a familiar issue for you, is this hereditary in your family...).
If yes, please list them here.
Have you ever seen a homeopath before? *
I have read and understood the confidentiality statement. *
I understand that a donation is requested! *