Online Consultation Form
Before your first consultation, please fill in this online consultation form with your personal details, brief description of your chief problem and some basic information about yourself.
Feel free to skip any of the fields if they do not apply to you (e.g. in acute ailments) or those you do not wish to discuss.
For privacy reasons, the form is not stored in any database and is e-mailed directly to myself. After you have finished, click on the "Submit Form" button in the bottom of the form. You will receive a confirmation e-mail shortly.
Fields marked with * are required.