Patient Inquiry

Practice 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.

Jörgensen diagnosis (acid-base) Bach flower therapy Drainage procedures Spenglersan diagnosis Point measurement of heat Kinesiology Nutrition therapy BE-T-A Messung ANSA measurement of the autonomic nervous system Heavy-metal drainage Artery Stiffness Index (ASI) Allergic diagnostics (also specifically nutrition diagnostics) Acid-base diagnosis Self-blood therapy IPT (lnsuIin Potentiation Therapy)

You are here: Patient Inquiry

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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