Cancer only Consultation Form

I thank you for booking my "Cancer only Consultation". My advice will only apply to your cancer condition. If you wish me to help you with other health problems, you should upgrade to a full consultation here (you still need to fill this form, even if you upgrade). 

Please answer all the questions truthfully.

If you have recently made changes to your diet please tell me. I am mainly interested in your diet prior to the onset of your disease. If you have made changes recently, please specify so in the box supplied on this form.

Soon after I receive this form back I will contact you to fix a date and time for the consultation.

Patrick

Please note that all fields followed by an asterisk must be filled in.
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