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Registration for Online Video Consultation

Details: ZOOM video call of approximately 40 minutes, €95,-.

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


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

    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?

    After submitting the form, you will receive an auto-reply with confirmation and further details to your email (please also check the spam folder).

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    Privacy notice: The information submitted will remain private and will be available only to the members of the Crystal Touch team. This information will be used only for the purpose of this analysis, unless requested otherwise by you. The information and photos are not shared with any third party or anyone else outside of Crystal Touch without your permission. Read the Terms & Conditions for more details.