Contact Form

Contact Form

Please use the address on the left to contact me. If you would prefer, you can send me a note directly from this page. The form below includes several questions. None of them are mandatory, but the more I know, the better I will be able to assist you.

Patient Name
Age
Ethnicity/Nationality
Nation of Residence
Other illnesses before you HES developed?
Any allergies?
Any allergies in the family?
What are the symptoms?
What tests have been performed? Results?
What treatments have been prescribed? How long?
Doctor's Name & Address
Please use this space for your questions or any other information you would like to provide.
Your Email Address:


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