Treatments & Clinics in Germany
Alternative Cancer Connection - There are over 20 alternative cancer clinics in Germany that treat international patients. I want to suggest ones that would work best for you and your situation. Please take a few moments to fill out this form so that I can help you find treatments in Germany that are best for you. -- Colleen
Patient Name *
Your answer
Email *
Please double-check that your email address is correct, otherwise I can't email you back. Your information will only be shared if you want me to connect you with the clinics.
Your answer
Phone number
Please include the country code if outside of North America.
Your answer
Where are you located? *
Your answer
Type of Cancer *
Your answer
Your Name and Relationship to the Patient (if the patient is not completing this form)
Your answer
How long would you like to stay in Germany? *
*If other, please explain
When would you like to arrive in Germany? *
*If other, please explain
Where would you prefer that the clinic be located?
Will you have a companion or family with you, or would you be traveling on your own? *
*If other, please explain
Do you want to stay in-patient at a clinic with meals included, or stay at a hotel or apartment without meals and travel to & from the clinic each day? *
*If other, please explain
Clinics charge for each round of treatment (between 2-6 weeks). And some recommend that you return again in the future. What is the total amount you are able to pay for a first round (2-6 weeks) of treatment, accommodation, and food? *
Are there any treatments in particular that you are most interested in receiving?
Your answer
Do you have any special needs related to physical, mental, or emotional concerns? (ie, use a wheelchair) *
Your answer
Do you follow a specific food diet that you would like the clinic to accommodate?
Your answer
Do you speak German and/or English? *
*If other, please explain
Were you referred to me? If so, who may I thank for referring you? If not, how did you find out about me?
Your answer
Have you emailed or talked to any clinics or doctors in Germany? *
If yes, please list them in the "other" option.
Do you have recent blood test results, pathology reports, and/or scans in English? The next step will be to email them to me [Hello@AlternativeCancerConnection.com] so that I can forward them to the doctors. *
If other, please explain.
Is there anything you would like me to know?
You don't have to, but feel free to include your age, specific questions for me, treatments you've already tried, why you are interested about treatment in Germany, and anything else that you would like me to know.
Your answer
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