Remedy Collection Form

Student’s Name:
Social Security No.:
Student’s Address: 

This is a fieldwork assignment on home remedies. Folk remedies have a

long history in most cultures and are well represented as in our area

and in Mexico. The goal of this assignment is to research folk remedies

which are found in our area. This should help in arriving to a better

cultural understanding of the Lower Rio Grande Valley of Texas and folk

medicine in general. You can be your own informant. If you can bring some

of the herbs to class please do so. If you need extra pages for the answers

add as many as you need to this questionnaire.

I. The Remedy: …………………………………… 

A. The ingredients [herb(s) and/or other substance(s)] used 
in the remedy:

In Spanish:

In English:

B. What does this remedy cure in this example?

C. Does it cure other maladies?

D. Preparation:

1. List the amount [as closely as possible] of each 
ingredient used:

2. How is each ingredient obtained [Are they bought, grown 
or collected]?

3. How is the remedy prepared?

4. How is it used or taken?

5. How often is it taken?

6. Example of its use:

2. The Illness:

A. Name of the illness:

In Spanish:

In English:

B. What causes this illness or condition:

C. Its symptoms:

D. Is there another home remedy that will cure it?

III. Students comments:

IV. Contextual Information:

A. Approximate date informant first heard of remedy:

B. Relationship of the informant to the individual from 
whom the informant heard the remedy:

C. Circumstances when remedy was first heard:

V. Give the following information on your informant:

Name:

Age:

Sex:

Place of birth:

Ethnic group:

Languages spoken:

Marital Status:

Children:	Male:	Female:	None:

Religion:

Education:

Occupation 1:

Occupation 2:

In which town did you interview your informant?

In what kind of location did the interview take place?

Date interview took place: