Name:                                Female        Male

City and State/Province:           Country:

E-mail:

Please tell us about your training and practice.

	No. of Years Studying Homeopathy: I don't study Less than 3 3 to 5 years 5 to 10 10 to 20 Over 20 years	No. of Years in Practice: I don't practice Less than 3 3 to 5 years 5 to 10 years 10 to 20 years Over 20 years
	How would you describe your practice? Select one only. I don't practice Use homeopathy for family and friends only Lay practitioner Doctor practicing homeopathy full-time Doctor practicing homeopathy with some patients Professional homeopath Practicing adjunct therapies including homeopathy
	Homeopathic school attended?
	Do you participate in a study group?       Yes     No

Qualifications:
Please select all that apply.
Lay Practitioner Heilpraktiker RSHom. Medical Doctor Naturopathic Doctor Doctor of Osteopathy Doctor of Chiropractic Doctor of Hom. Med., India Soc. of Homeopaths, UK Member Faculty Hom. GB Doctor of Hom. Medicine Diploma in Hom. Medicine & Surgery Dip. of the National Board of Hom. Examiners Diplomate of Homeotherapeutics	Bachelor in Hom. Med. & Surgery Bachelor in Medicine Bachelor in Surgery Registered Nurse Nurse Practitioner Licensed/Certified Acupuncturist Doctor of Oriental Med. Practitioner of Classical Hom. Master's Degree Pub. Health Physicians' Assistant Dip. Hom. Academy of Naturopathic Physicians Certificate in Homeopathy (AACH) Other:

What do you think of Homeopathy Online?

	On what topics would you particularly like Homeopathy Online to focus?
	Please select all that apply.
	Philosophy Repertory Study Materia Medica Materia Medica of small remedies Constitutional care Acute care		Pediatrics Veterinary Case-taking Education Adjunct therapies Other:

Additional comments?