Online Email Consultation: In order for our herbal medicine practioner to have a clear picture of your situation, please fill out the short questionnaire below. If possible, attach photo(s) of the affected area at the bottom of this form. After you have submitted the form, it will be sent directly to Dr. Li for her review. Please allow 1-2 business days for a response.**
Patient Name (if different)
Your Email Address: (Required)
Verify Email Address: (Required)
Cell Phone Number: (Optional)
How many years have you had Vitiligo?
Which part of your body does the Vitiligo affect?
How Serious do you think your Vitiligo is?
Do you have any family member who has Vitiligo?
Do your white spots keep spreading?
Have you tried any alternative treatment?
How did you hear about us?
(such as Google, WebMD, etc..)
You may attach (optional) Pictures to help Dr. Li understand the situation: