Form history

In advance of your thirst treatment it is required to fill out an anamnesis
form (medical history) thirst. This will only take a very short time. It is
advisable that you thoroughly go through the questions in order to answer
the questions correctly. (Download anamnesis form).

After you filled out this form entirely and put your signature you can send it to:

Brinkenheide B.V.
Hessenmeer 80
3852 NZ Speuld (Ermelo)
Netherlands

After receipt of your anamnesis form we will contact you as soon as possible. (approximately within 5 working-days).

If you rather wait filling out the anamnesis form and wish to visit our practice
thirst that is naturally not a problem. If you wish we can assist in filling out the
form together.

It is also possible to send a urine sample first in order to receive a diagnosis and
to give you an idea of the treatment possibilities for your disease.

If you have got any questions or wish to make further enquiries w.r.t. the medicol®
colour resonance therapy, you can contact us at any time:

Phone: (0031) 577407018 or (0031) 610703048 (you can also send a text-message if you wish)