Book Your Homeopathic Consultation

Your Patient ID:
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1. Basic Information

Full Name *

Age *

Gender *

Country/Time Zone *

Email *

WhatsApp/Phone *

2. Consultation Preference

Consultation Type *

Initial (€70)

Treatment Package (€199) ⭐ BEST VALUE

Follow-up (€55)

Preferred Contact Method *

WhatsApp

Zoom

Google Meet

3. Medical History

Main Complaint/Reason for Consultation *

When did this problem start? *

🎯 Key Symptom Modifiers (Critical for Prescribing)

What makes your symptoms BETTER? *

💡 Crucial for finding your remedy – be specific!

What makes your symptoms WORSE? *

📋 I want to provide detailed information (Recommended for chronic conditions)

Includes: sleep, appetite, emotions, weather sensitivity, family history

I understand that homeopathy is a complementary therapy and does not replace conventional medical care. I will not discontinue any prescribed medication without consulting my doctor. I consent to the consultation and understand that results vary by individual. *