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Name of your RLHIM doctor if you are a patient:

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Patient Patient's Relative or Carer Friend or Supporter of the RLHIM Unable to get a referral GP Nurse Other Health Practitioner

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I would like to receive news from my local group and give permission for my name, email and/or phone number to be passed onto the local organiser.

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No Yes

We are gathering together statements and testimonies of how homeopathy has helped to improve peoples’ lives for the better as part of a project to challenge negative stories and articles against homeopathy on the NHS. Please indicate here if you are willing to help in this way

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No Yes

If you wish to Support the Campaign but do not wish to share your story, go to the Submit button at the bottom of the page now.

If you are willing to be interviewed, write letters and put your name to supportive statements that can be used in the media and on our website, please provide the following further information:

I use homeopathy and *

Conventional medicine Other Complementary therapies

Please state what other complementary therapies you use (e.g. acupuncture, herbal medicine, etc):

Give a brief description of how you became interested in homeopathy.

I first became interested in homeopathy ... *

Give a brief description of how homeopathy benefited you or someone you know.

Homeopathy helped ... *

I agree that you can use my story or contact me for further information;

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IMPORTANT NOTE: All information given will be handled with care and sensitivity. It will only be shared with our marketing partners who may contact you to obtain further details to help the Campaign.

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