Magnecare Consultation Form

Your Name

 

 

 

Email address, fax number or address to where we can send your reply.

 

 

 

 

Telephone number

 

 

 

Gender

 

 

If relevant, age weight and any special dietary measures you take

 

 

 

 

Details of the dis-ease or problem

 

 

 

 

 

 

 

 

Have you tried using magnets before?