Medical form to determine the best natural treatment for the patient

Please, fill up the below form the more accurate possible so we can forward this information to the doctors and specialist to assess your case. If you have questions about how to fill it up, contact us via phone (+34 952 368 146) or email: and we will help you kindly.

If you have available updated medical information, with tests, reports and images, you can send them to us to assess better your case. Those files must be updated and the most recent possible.
This form does not compromise you to have a consultation with us, but it will help us to know if we can treat you with our therapies or other specialist’s therapies and therefore you may know if you case has a possible treatment.


If you have pain, tell us where and level of pain (required)

Blood Pressure (required)

Have you experienced excessive weight problems? (required)

Trouble falling asleep or insomnia? (required)

Do you suffer from Constipation? (required)

Would you be interested in having an online medical consultation with us?

If you want to upload any file to provide more information for a health evaluation, select your file:

Accept the Legal and Privacy Policy


This application does not compromise you to hire our services, and the purpose of this is to assess your state so we are able to tell you if your health condition can be treated by us or not. If you can be treated, we recommend you to have a medical consultation to receive more information from you so we can tell you about all the possibilities of treatment with us or with other professionals in medicine. The cost of the first medical consultation is € 90 in which you will be told about many courses of action you can take in order to treat your condition and/or minimize its symptoms to achieve a better quality of life in case it is incurable. The answers of this application will be forwarded to our team of physicians and they will assess your case. You are entitled to have a response to this application in terms of knowing if we can treat you or not, or in case we can’t, we can refer your case to another medical professional or specialist. Thank you for your interest.


In accordance with the Organic Law 15/1999 on the Protection of Personal Data, we hereby inform you that your personal information will be included in an authorized file under the responsibility of “Clinica Biomedic” in order to carry out our obligations to you of contacting you and offering you the best service. We keep your personal information private and secure. Our secure servers protect your information using advanced encryption techniques and firewall technology. Also, please note that you can exercise your right to access, cancel, correct and object by sending a letter or email to: with the postal address shown above.