Symptom Survey
Tissue Mineral Analysis
Telephone Consultation
email Consultation

HomeAbout Doc Eva Services Products

SERVICES

PATIENT INFORMATION FORM

Last Name: First Name: Address: Address2: City: State: Zip: Home Phone: Work Phone: E-mail: Sex: Birthdate: Would you like your report via email If no, your report will be sent via USPS mail

Please send a check or money order for

$80.00 US Funds for Symptom Survey
or $125.00 US Funds for Mineral Analysis
or $120.00/per hour US Funds for Telephone Consultations

Mailing address for payment:
Dr. Eva Urbaniak
811 W. Bender Rd.
Ellensburg, WA 98926

If you have questions for Doc Eva, please feel free to email her at docevaonline.com

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