Ask Dr. Helen Evaluation Form

Please fill out the form below so that I can better assist you in choosing the right product.

If you want to contact me regarding a testimonial or general inquiry not related to a product you can fill out this contact form. Your comments and suggestions are appreciated.

Contact Information
Full Name:
Email Address:
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Fill out this standard information that I need to know to make an evaluation
Age:
Regular menstral cycles:	Yes   No
Hysterectomy:	Yes   No
Medications Used:	Rx, Herbal, etc
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Comments and Questions

Of course you can always contact me by phone, email or written letter.

	Email:	info@askdrhelen.com
	Phone:	(714) 542-8333 (714)744-0333
	Toll Free:	(800) 301-1982
	Fax:	(949) 733-1877 (949) 856-4574
	Write:	P.O. Box 7530 Newport Beach, California 92658