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REQUEST A CONSULTATION OR SERVICES

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CURRENT HEALTH ISSUE(S)

Select the Main Type Of Homeopathic Care

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What is the ONE (1) main health issue for which you are seeking homeopathic care.

How long has the ONE (1) main health issue been a health condition?

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What are the CURRENT HEALTH ISSUES occurring now at the same time?

Select all that currently apply.

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Name each current or suspected diagnosis, in chronological order with the year it started after each.  

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Number of total current diagnoses


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or suspected current diagnosis(es).

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ADDITIONAL COMMENTS

COMMENTS: Please provided us with more general details on the nature of your inquiry. Please add your comments to submit this form. You must submit something below to submit this form.

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