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Registration Form

Thank you for reaching out and welcome to Gil Ton AcuMed clinic. Please fill-out the registration form below and sign it.

You are asked to write Yes / No in the appropriate question:

Signature: By signing this, I understand that the provided treatment (Acupuncture, Laser Acupuncture, Chinese herbal medicine) is part of Chinese medicine treatment modalities for the purpose of helping me to improve my health and wellbeing. As well, I understand that Dr. Gil Ton Ph.D is not a General Practitioner in the Netherlands and the treatment is not a substitute for medical diagnosis or treatment, which if needed I'll contact the General Practitioner.

Please Note:

1. The treatment for children requires the consent of both parents with custody according to the law.
2. Cancelation policy: Please contact Gil Ton by email or phone at least 24 hours in advance to cancel or reschedule your appointment otherwise you'll be charged for the appointment. Thank you for your time and understanding.
3. Wear comfortable clothing and eat before the treatment ( it is recommended not to have a session on an empty stomach).