Appointment Form

Appointment Request Form

Let us know how we can help you!
Full Name*

First NameLast Name
Phone Number*
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please describe your symptoms / complaints in detail, chronologically.
Symptoms / complaints in detail
How did you hear about us?
Referral?
Appointment date & time

Kindly select your desired location and time for an appointment. Due to schedule programming, each time block is set to 1 hour. However, duration may vary depending on case. You will receive an e-mail or WhatsApp message confirming the appointment.
Preferred appointment location.*

Singapore - DempseySingapore - CBDSingapore - Katong i12Kuala LumpurOnline
Singapore appointment - CBD (Anson Rd)*
Singapore appointment - i12 Katong*
Singapore appointment - Dempsey*
Kuala Lumpur appointment*
Online appointment*
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Homeopathy New Consultation
$ FreeSGD Quantity

Homeopathy Follow up Consultation
$ FreeSGD Quantity

Total

$0.00SGD
I understand that Homeopathic Treatment is not intended to replace the advice of my / my child’s primary care physician.

Yes
I understand that Homeopaths do not diagnose conditions and that it is solely my responsibility to be tested for conditions through my primary care provider (applicable also to my child/children).

Yes
Prior to your appointment, kindly send details on your diagnosis and/or treatments; e-mail or WhatsApp in advance:

-blood test report
-investigation reports, e.g. X-ray, ultrasound, MRI
-psychological / psychiatric assessments
-bioenergetic tests (quantum-qi, EAV)
-allergy report (if applicable, IgE, IgG tests)
-current conventional medicine prescriptions
-nutritional or herbal supplements, traditional medicine, homeopathic remedies
-history of any other treatment.

Please reflect on what bothers you most as a person and be ready to talk about it.

(Children should be accompanied by someone who knows the child's lifestyle, sleep, diet and habits well. He/she should be able to share the child's physical, emotional, mental and behavioural changes before and during the illness.)
Please upload any medical or diagnostic records, lab reports, imaging results (X-rays etc), if available.

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Payment Methods

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Appointment Request Form

Appointment date & time