Free online consultation

This form is only for the purpose of initial health consultation. The personal ID information will be strictly kept confidential, and only accessible to the health consultant. It is NOT released to any other parties without written permission from the clients.

For some questions, you can leave it blank If you are not sure or not applicable. This questionnaire will be used as initial case records to be compared with the changes and effects during the treatment process.

Please fill the form to the best you can and our clinic experts will be in touch with you to discuss your symptoms and possible treatment strategy. If any questions, please contact us.

 

Once the questionnaire is lodged, our specialists will be in touch with you shortly.