Port Alfred: Jared Meyer: Online Consultation

Select your condition(s) from our INDEX below, and we will reply with what YOU need, how much it will cost and what the next step is.

Please do not select and/or combine conditions for other family members, children, pets etc. One Consultation form per person or pet please.

Name *

Contact Number *

Contact Email *

Please check that your email address is correct.

Subject *

Agent *

Country *

Your condition/illness

Your condition/illness that is not listed above (if applicable)

Year of initial diagnosis (if applicable)

Your Age *

Your Weight (kg) *

If you have cancer, it is important for us to know if your cancer is ER-positive (estrogen-positive) *

Not Applicable

ER-positive YES

ER-positive NO

List the medication(s) you are currently on *

Please list ALL medication, including health/food supplements.

Anything you want to add that we should be aware of?

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VERY IMPORTANT

If you suffer from MULTIPLE ILLNESS, we COMBINE the Protocols selected by you into a single Treatment Protocol.
Any additional Protocol requests for family members, friends, pets etc MUST BE SUBMITTED SEPARATELY.
EACH SUBMISSION MUST PERTAIN TO ONE INDIVIDUAL ONLY.

Please make sure your email address is correct before you send.