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Please fill in this form and send it to me. I will get in contact via email with instructions of remedies and how to take them.
I may ask you some further questions if necessary.
All fields are required, so write "none" rather than leave it blank.
The information provided is strictly confidential.
Please fill in this form and send it to me. I will get in contact via email with instructions of remedies and how to take them.
I may ask you some further questions if necessary.
All fields are required, so write "none" rather than leave it blank.
The information provided is strictly confidential.