Britta Gisder Classical Homoeopath

Consultation Form

Use this form only if you are intending to purchase a homoeopathic immunisation or first aid kit or
for a homoeopathic ACUTE treatment
If you are an existing client and are having any queries, please contact me Click here to email me.

Name:
Date of birth (dd/mm/yy)
Age of patient
Sex	Male Female
Address
Post Code
Country
Email Address:
Phone number with area code you can be contacted on
Description of your Symptoms: Please enter a detailed description of your symptoms. Please state the onset of illness sudden/slow, what color of face/tongue/throat and color of discharges like phlegm/stool/urine etc). Describe any pain you feel and what makes it better or worse? Are you restless/ lethargic/dull. Better from fresh air or for warmth in bed, lying down or moving around. The more detail you give me the more accurate will be the prescription. If I need more information I will contact you
How did you hear about me?

create web form