Enter your info

Please answer this questions. I need basic info about you (or your family member) and your problems. I will contact you soon.

Your name

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City

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Country

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Mobile phone number (include country and area code)

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Which messenger app you use on mobile phone?
Whatsapp
Viber
Skype
Facebook messenger
Other

Other messenger:


Name/Nickname on messenger (if applicable)

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e-mail address

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Date born

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Specify your health problems.

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What drugs do you currently take?

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Have you ever been treated with alternative medicine? Which methods?

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