Registration for Online Video Consultation

Please fill in the registration form below. After your registration, we will email you with the following steps, including payment and available time slots.

If you have any questions or concerns, please send us a message at info@crystaltouch.nl. You can fill in the form in English, Dutch, Ukrainian or Russian languages.

Registration

    What caused your facial palsy?
    Unknown reason (Bell's palsy)Herpes virus (Ramsay Hunt)Last weeks of pregnancyCongenitalOperation (surgery)TraumaOther. Please specify:

    Affected side:

    What treatments/medication did you take during the acute period?

    Which therapy was prescribed and taken?

    When did the first signs of recovery appear?

    When did the improvements slow down or eventually stop?

    What treatments did you take during the last 3 months and what were the results:

    What complaints about your face and facial movements do you have at the moment (as detailed as possible):

    Comments or questions:

    How did you hear about us?


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