Medical Consultation Form

If you would be interested in having a one-to-one online medical consultation with Dr Kriege, please fill out the following form and press ‘submit’.

Which kind of medical professional would you like to make an online appointment with? (You can select more than one)

Medical doctor
Functional / Integrative medicine practitioner
Nutritionist, nutritional therapist or dietician
Psychotherapist

Please select the date (as accurately as you can) that you first noticed symptoms/tested positive for COVID-19?

Which of the following symptoms do you currently have?

extreme tiredness (fatigue)
shortness of breath
chest pain or tightness
problems with memory and concentration
difficulty sleeping (insomnia)
heart palpitations
dizziness
pins and needles
joint pain
depression and anxiety
tinnitus, earaches
feeling sick, diarrhoea, stomach aches, loss of appetite
a high temperature, cough, headaches, or sore throat
changes to sense of smell or taste
rashes

Do you have any symptoms that were not listed above? If so, please specify.

How long have you had these symptoms?

Please list any medication and/or supplements that you are currently taking.

Are you seeing any doctors, consultants, nutritionists, functional/integrative or other medical specialists currently? If so, please specify.