In order to provide a safe and efficient counsel, please fill in the form below to give us the necessary information and insight into the condition. Based on this information we will make an assessment to determine if the patient is eligible for counsel and provide information on further steps, as explained below.
- Please fill in the form below. Please send any additional information and documents to the address: email@example.com
- We will review the information and determine the eligibility for further counsel. Generally, we provide preventive consulting for patients without medical records and diagnostic consulting for patients with diagnosed conditions a
- .comnd full medical records. You can find out more about our services and pricing here.
- If you agree to become our patient, we will e-mail you the invoice. After receiving your payment, we will provide you with written medical counsel. Video consultation is also available when possible.