Request for General Consultation
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Please fill out the following information. The cost of consultation is $150 via Skype/telephone and $200 in Dr. Kulisz's private office. Length of the consultation is one to one-and-half hour. Please forward, within 48 hours, any pertinent documents (doctors' opinions, analyses, etc...) for the last 6 months pertaining to the condition for which the consultation is requested. They can be uploaded at the bottom of this form or emailed to marywhite@kulisz.com. They can also be faxed to 661-459-2329 (use country code 1 if faxing from the outside of the United States/Canada.)

After completing this request, click "SUBMIT". You will be transferred to the PayPal site to complete the payment. We will contact you soon.

Thank you for entrusting us with your health needs.
World-Wide Naturopathic Health Service
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IMPORTANT NOTICE: There is no obligation of any kind whatsoever to buy any naturopathic formulations, remedies, or supplements from our dispensary. For more information go to http://www.kulisz.com/practice/office-fees/
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Ver 1.2
  • / /
  • Full years
  • In inches or centimeters
  • Select inches or centimeters
  • Round up to full number
  • Select pounds or kilos
  • Example: 130/80. Enter 999/99 if unknown.
  • Total LDL HDL
    Cholesterol
  • Please tell us how is your overall health comparing to previous assessment.
  • No hyphens, no spaces. Non US and Canadian filers, please include country code.
  • In the next field "Other", please tell us how did you find us if not referred by Dr. Kulisz or Dr. Dahlmann.
  • If none, write 'None"
  • If none, write "None"
  • If none, write "None"
  • Write here questions you want ask and provide additional information that you feel is pertinent to your health. If none, type "None"
  • Upload additional information (drs opinions, analyses reports, x-rays, etc...) that you think may be of importance.
Version 10.0