Patient History Form
A completed Patient History form and a Symptom Survey Form are required when you see Dr. Leff for the first time.
You may download and print the two-page Patient form as well as the Symptom Survey Form and complete them at your leisure, but please bring the completed forms with you on your first visit. These forms are available for you to download in Adobe PDF format. You may then open the forms in Adobe Acrobat Reader, print them on your printer and complete the information. Please note that you are not able to type into these forms and email them to us, all pages must be printed, completed and brought to the office on your first visit. Please follow these instructions to download a copy of each form requested by Dr. Leff: Right Click on the form name select the “Save” option Remember the name of the folder to which you are saving the file Launch your Acrobat Reader program open the file print the number of pages indicated for each form PatientHistory Form (two pages) Symptom Survey Form (five pages) Menopause Questionnaire (one page) Thyroid Questionnaire (one page)Biotoxicity Questionaire (one page) Symptoms for Saliva Test (two pages) Symptoms for Bloodspots (two pages) Note: If you do not have the Abobe Acrobat Reader program, you may download a Free copy by Clicking Here. |
Patient History Form
Patient History Form
Patient History Form
Patient History Form
Patient History Form
Patient History Form
Patient History Form
Patient History Form
I'm 55-year-old from Korean, I was diagnosed with second-stage liver cancer following a scheduled examination to monitor liver cirrhosis. I had lost a lot of weight. A CT scan revealed three tumors; one in the center of my liver in damaged tissue and two in healthy portions of my liver. No chemotherapy or radiotherapy treatment was prescribed due to my age, the number of liver tumors. One month following my diagnosis I began taking 12 (350 point) Salvestrol supplements per day, commensurate with my body weight. This comprised six Salvestrol Shield (350 point) capsules and six Salvestrol Gold (350 point) capsules, spread through the day by taking two of each capsule after each main meal. This level of Salvestrol supplementation (4,000 points per day) was maintained for four months. In addition, I began a program of breathing exercises, chi exercises, meditation, stretching and stress avoidance. Due to the variety of conditions that I suffered from, I received ongoing medical examinations. Eleven months after commencing Salvestrol supplementation But all invalid so I keep searching for a herbal cure online that how I came across a testimony appreciating Dr Itua on how he cured her HIV/Herpes, I contacted him through email he listed above, Dr Itua sent me his herbal medicine for cancer to drink for two weeks to cure I paid him for the delivering then I received my herbal medicine and drank it for two weeks and I was cured until now I'm all clear of cancer, I will advise you to contact Dr Itua Herbal Center On Email...drituaherbalcenter@gmail.com. WhatsApps Number...+2348149277967. If you are suffering from Diseases listed below, Cancer, HIV/Aids, Herpes Virus,Bladder cancer,Brain cancer,Colon-Rectal Cancer,Breast Cancer,Prostate Cancer,
ReplyDelete?Esophageal cancer,?Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,?Hodgkin lymphoma
?Intestinal cancer,Kidney cancer,Leukemia,Liver cancer,Lung cancer,Melanoma,Mesothelioma,?Multiple myeloma,?Neuroendocrine tumors,Non-Hodgkin lymphoma,?Oral cancer,Ovarian cancer,?Sinus cancer,Skin cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer,Testicular cancer,Throat cancer,Thyroid Cancer,?Uterine cancer,Vaginal cancer,Als,Vulvar cancer,Hepatitis, Chronic Illness. Lupus,Fibromyalgia.