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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
(Required)
Birthday
Year
Month
Day
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
When would you like an appointment for? (please note we will try our best to accomodate your request. If the slot is already taken, we will come back to you with alternate options within 24 hours).
(Required)
May - Jun 2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
31
Sunday, May 31, 2026
1
Monday, June 1, 2026
2
Tuesday, June 2, 2026
3
Wednesday, June 3, 2026
4
Thursday, June 4, 2026
5
Friday, June 5, 2026
6
Saturday, June 6, 2026
Week starting Sunday, May 31
Time zone: Coordinated Universal Time (UTC)
Phone call
Friday, Jun 5
10:00 AM - 11:00 AM
11:00 AM - 12:00 PM
12:00 PM - 1:00 PM
1:00 PM - 2:00 PM
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