Salud Integral Treatment procedures

Medical Overview

In order for our medical staff to be able to accurately determine acceptability and proper dosage, patients will be required to submit their medical records to the offices of Salud Integral for review by our medical staff prior to being accepted for Anvirzel™ therapy.

Patients need to provide the completed Medical Overview Form and copies of their medical records that include physician report summaries of their current status and prognosis, medical history, evolution of disease and laboratory test results (Blood Work results and interpretations of Biopsy/Pathology, CAT Scans, MRI, PET etc.).

(Best completed in Google Chrome or Firefox Browser, you may get errors if viewed and completed in Internet Explorer Browser.)

Optionally, you may download, complete and return to us this  pdfPDF Version of the questionnaire.
PLEASE NOTE: The Adobe Acrobat Reader or similar is needed to open and view this file.

Please enter the patient's name
Please enter a valid email address
Please enter the patient's age
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Please make a selection
Please enter your complete address here
Please enter the physician's name here
Please enter your initial diagnosis here
Please enter date of diagnosis
Please describe the progression of the disease
Please describe your current treatment here
Please enter other medical conditions of patient here
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Please select one from list which best describes the performance status of the patient.
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