Are you ready to connect with the wisdom of your body?

Individual request form.

This form fully protects your privacy.

With a holistic approach to rebalancing your health, private meetings create a safe environment with a focus on the person, not the disease. Together we seek to find the right solution for you.

This form is intended to help me understand who I will be meeting with and how to structure an accompaniment that is specific to you.

Once you have filled out the request form for an individual session, we will contact you within 24/48 hours to agree on the modalities of work and the value of the exchange.

First and Last Name

Mail

Pronouns

Age

Phone and means of contact (whatsapp or telegram)

City of residence

What brings you to the individual consultation? (Write as specific and synthetic as possible)

Last consultation with a gynecologist (complete if you consider that this question corresponds):
briefly detail the date, what this health professional told you, if he/she indicated any treatment and if you had any tests (what type and with what results).

Have you ever consulted with any other integrative therapist on this subject?
If yes, please give us a brief description of how the consultation/treatment worked out for you.

Have you had any surgical intervention in the past related to your sexual organs?

Did you take or are you taking any type of hormonal contraceptive or other type of medication? For example, anti-inflammatories, anti-histamines, supplements, etc.

Any specific topic you would like to mention related to your sexual organs, whether it is a medical diagnosis or something additional you would like to share?