Formular de evaluare online gratuită

Request a free online assessment

Fill out the form below with the information and questions you want to send us, and the Akeso clinic specialists will send you their recommendations.

This form does not replace a consultation, so the Akeso clinic team will not give you a diagnosis, but guidelines based on which you will be able to learn more about your health condition.

We are here to answer your questions and support you in finding your balance and well-being.

Contact details:

Name and Surname of applicant:

Phone:

Age

E-mail:

Medical data:

Height (cm):

10

Weight (kg.):

5

What symptoms do you have (what do you feel)?

How long have you had these symptoms?

Have you been to a doctor before and what specialty did he have?

What diagnosis have you received so far if you have been given one? (What disease have you been told you have?)

What other diagnoses (diseases) do you have?

What surgery, treatment or support interventions (nutrition, psychotherapy, physical therapy) have you had?

What medications/supplements/teas have you taken and are currently taking?

I agree to the storage and use by the Akeso clinic of the data provided by me by completing this free consultation form, according to
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Address

Google Maps location

Phone

+4(0) 746 242 707

Appointments calendar

Schedule of appointments

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Free online evaluation form

Contact details:

Medical data:

Address

Phone

Appointments calendar