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Health Assessment
Questionnaire -- Electronic Filing Part 1
NOTICE:
This questionnaire requires MS
Internet Explorer ver. 6 or higher to be transmitted without errors.
Using other browsers may transmit this questionnaire with distortions or not
transmit at all.
To be better prepared for your appointment we ask you to fill this Health
Assessment Questionnaire which is the equivalent of about two-hour
interview. It provides a substantial insight into your state of health
in the context of nutritional deficiencies and allows us to understand
your needs better.
Dr. Kulisz's health improvement programs are entirely based on the use
of natural substances, nutrition, exercises, and lifestyle adjustments specifically
developed for individual clients. Under no circumstances we suggest,
prescribe or otherwise indicate use of synthetic medicines as the health
problems are not created by the deficiency of such. For more
information who we are what we do click here
For the scope of Dr. Kulisz's practice and
office charges
click here. For disclaimer
click here.
There
is a fee of US$49.95 for the transmission and processing of this
questionnaire (US$75.00 if filed by
fax) plus an additional fee for an
appointment or telephone consultation ($75.00 to $250.00 depending on length and complexity).
Estimated office charges will be provided at the time of setting up
the appointment.
Please pay
the questionnaire processing fee using PayPal secure payment facility
After completing the payment you will be
transferred to the questionnaire page
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