Questionnaire | Your therapy

Your information in this questionnaire is relevant for your individual therapy and holistic treatment. Please take enough time to answer the questions as fully as possible. Your answers are used to plan the examination at the first consultation.

Send the completed questionnaire by e-mail, fax or mail back to us directly. You will be contacted within a few days regarding arrangement of an appointment. Please take with you the eventually obtained findings for the initial consultation.

 


normal
little
much
normal
little
much
normal
little
much
normal
little
much
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
skin
Nails
intestine
genital area
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No