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Homeopathy Health Clinic
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Follow-up Consultation Booking Form
(30 mins)
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First & Last Name
(Required)
Patient Reference # - mentioned on the prescription
Phone
(Required)
Email
(Required)
How many days since start of remedy?
(Required)
Have you taken remedy regularly prescribed?
(Required)
Please mention changes in symptoms after taking the remedy.
(Required)
Meeting requested
In-person
Virtual
Clinic Location for in-person meeting
Grimsby
Burlington
Hamilton
St. Catharines
What are the preferred days of the week for appointment
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Preferred time or time range for appointment
Any other comment / note / request
Submit
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