Patient Inquiry

Practice
Dr. med. Siebenhüner
Vilbeler Landstrasse 45 B
60388 Frankfurt
Phone +49 (0) 69 63 20 00
Fax +49 (0) 69 63 70 77

Our Surgery Hours
Mon - Fri: 8 a.m. to 6 p.m.

Oxyven therapy acc. to Regelsberger Budwig therapy Ukrain therapy Drainage procedures Chirotherapy Nutrition therapy Thermoregulation diagnosis Homeopathy Food Intolerance Test Breuss therapy lnfusion stabilising therapy Hyperthermia Biotherapeutic drainage of environmental poison Self-blood therapy Herbal medicine

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Basic information

Gender (patient) *
First name (patient) *
Name (patient) *
Age (patient)
Town (patient) *
Country (patient) *

Note: Please carefully check your input. If you do not receive an answer, it is very likely due to an errornousely entered eMail address!

eMail-Address (patient) *
Phone
Fax

What kind of original cancer was diagnosed?

Date of first recognized indiations?

If another person is writing for patient - Writer's name:

Gender
First name
Name

What Therapies have been undertaken

year: 1st: result: year: 2st: result: year: 3st: result: year: 4st: result: year: 5st: result: year: 6st: result:

Informationen about condition

Known metastases existent? If yes: Where?

Pains? If yes: What kind & where?

Current situation?

Patient's current condition? (please select one)

100: Normal

90: Able to carry on normal activity; minor symptoms of disease

80: Normal activity with effort; some symptoms of disease

70: Cares for self; unable to carry on normal activity or active work

60: Requires occasional assistance but is able to care for needs

50: Requires considerable assistance and frequent medical care

40: Disabled; requires special care and assistance

30: Severely disabled; hospitalization is indicated

20: Very sick; hospitalization necessary; active treatment necessary

10: Moribund; fatal processes progressing rapidly

Patient's current medication:

Other current illnesses:

Patient's information

Patient needs special care...

Patient could travel...

to Frankfurt am Main: Yes No

Patient would come...

alonenot alone

Accomodation wanted...

Patient wants to know...

Chances of treatment by Gerhard Siebenhüner

Personal communication to Gerhard Siebenhüner:

Note: Gerhard Siebenhüner answers to all questions and eMails.
If you do not get a reply within two weeks, please assume that your mail has not arrived!

Important: If for technical reasons this form is not submitted, please send an ordinary mail to Gerhard Siebenhüner and include all information if possible! - Thank you for your understanding.

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