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1st Consultation

Complete the form below to make a first contact with us and get an overview of the status of the patient.
Complete the following fields; you can specify all you wish. In case of doubt you can leave the field blank.

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Monthly Clinical History:
Personal Data:
Name:
Surname:
E-mail:
Country:
Phone:
Medical Data:
Date of Birth:
Start of Sickness:
Corticoids:
Baclofen:
Anxiolytics:
Copaxone:
Inteferon:
Condition of the Patient:
Vision:
Balance:
Swallowing:
Phonation:
Upper Limbs:
Sensitivity:
Motoric:
Lower limbs:
Sensitivity:
Motoric:
Anal sphincter:
Defecation:
Urinary sphincter:
Urine:
Continence of urine:
Mental state:
Sleep:

Take measurements using metric tape
(use centimeters as measurement)

Left hand:
Right hand:
Left arm:
Right arm:
Left forearm:
Right forearm:
Left Leg:
Right Leg:
Left Shin:
Right Shin:

Comment:
Telephone:

0054 02322 49 5585
Monday through Friday from 10 pm to 17:30 hours in Argentina. Or leave a message.

From other countries,
0054 11 4361-2974
Monday through Friday from 10 pm to 17:30 hours in Argentina. Or leave a message.

Email:
roderick.tozer@esclerosis-multiple.com


Interview of Dr. Ayrad Omar by Claudio Dominguez.


First interview by Claudio Dominguez of Dr. Ayrad where the doctor tells us by way of introduction what the phytotherapeutic treatment is all about.
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