Book Consultation Book a Consultation Name* First Last Gender*GenderMaleFemalePreferred NameDate of Birth* Date Format: DD slash MM slash YYYY OccupationAddress* Street Address City State Post Code Country*CountryAustraliaNew ZealandEmail Address* Phone NumberBlood Type (if known)Reason and goal for your consultation*Please list current medical prescriptions*Please list current health supplements*We understand that sometimes it is not always possible to attend our clinic for many reasons. Now we have Skype it makes it easier to have a face to face consultation with your preferred practitioner in the comfort of your own place. With Skype we can physically see you and are able to make assessments to gain an overall impression of your health. Consultation fees are claimable through most private health funds, please check with your provider about your eligibility. Preferred Method of Contact*Preferred Method of ContactPreferred Method of ContactSkypePhonePreferred Session Time*Preferred Session TimeOne and a half hours $170One hour $120Half an hour $70Preferred day and time of session*How did you hear of us?How did you hear of us?Profile MagazineFacebookReferralWord of MouthRadio/TVTrade ShowSales ManagerGoogleOtherNameThis field is for validation purposes and should be left unchanged.
