Table 1 Basic model of the interview form

Name of the person interviewed:

Date of birth: ____/____/______

Sex: F () M ()

Address:

Schooling:

Profession:

Do you use medicinal plants?

Which ones?

What types of diseases can be treated with these plants?

Which plant parts are used?

() Roots

() Stem

() Flowers

() Leaves

() Bark

() Seeds

() Fruits

() Entire plant

How is the medicine prepared?

() Decocted

() Tincture

() Syrup

() Infusion

() Maceration

() Other

Municipality:

Date:

Name of the Health Agent: