Complimentary Consultation Form
Please be advised that the purchase of Dr.Zhang's book "Lyme Disease and Modern Chinese Medicine" is required before the complimentary phone consultation can be scheduled.
(from amazon.com or www.hepapro.com)

Your information will be kept strictly confidential and will not be shared under any circumstances without your written consent.
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  • Profile Information

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    (If unsure, please use your best estimation)
  • Please leave blank if you were not tested.
  • / /
    Please use your best estimation
  • Leave blank if there's no additional information to add
  • Please leave blank if you did not receive treatment
  • Please leave blank if you did not receive treatment
  • Symptoms Information

  • Please check if you experience any of these symptoms
  • Please check if you experience any of these symptoms
  • Please check if you experience any of these symptoms
  • Leave blank if there's no additional information to add
  • Your information will be kept strictly confidential and will not be shared under any circumstances.

    Please be advised that the purchase of Dr.Zhang's book "Lyme Disease and Modern Chinese Medicine" is required before the complimentary phone consultation can be scheduled.
    (from amazon.com or www.hepapro.com)

    Once you have completed and submitted this form, please contact the clinic at 212.573.9584 to set up an appointment for the consultation.